Provider Demographics
NPI:1104381748
Name:DEFRAITES, JOSEPH (FNP-C)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:DEFRAITES
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70044-0092
Mailing Address - Country:US
Mailing Address - Phone:504-434-2161
Mailing Address - Fax:
Practice Address - Street 1:4320 HOUMA BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2961
Practice Address - Country:US
Practice Address - Phone:504-988-8600
Practice Address - Fax:504-988-2690
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily