Provider Demographics
NPI:1952967507
Name:PERCLE, MELISSA GONDOLFO (APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:GONDOLFO
Last Name:PERCLE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5821 W END BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1931
Mailing Address - Country:US
Mailing Address - Phone:504-723-5297
Mailing Address - Fax:
Practice Address - Street 1:8050 W JUDGE PEREZ DR STE 3200
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-1741
Practice Address - Country:US
Practice Address - Phone:504-493-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-18
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203906363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner