Provider Demographics
NPI:1982939369
Name:VINCENT, MAUREEN SWEENEY
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:SWEENEY
Last Name:VINCENT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 PERDIDO ST
Mailing Address - Street 2:SUITE 3205
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1393
Mailing Address - Country:US
Mailing Address - Phone:504-568-4634
Mailing Address - Fax:504-568-4295
Practice Address - Street 1:3308 TULANE AVE
Practice Address - Street 2:FLOOR 6
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-7100
Practice Address - Country:US
Practice Address - Phone:504-826-2057
Practice Address - Fax:504-826-2052
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAS00274363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant