Provider Demographics
NPI:1104933167
Name:MCDUFFIE, ROBERTA H (CNS)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:H
Last Name:MCDUFFIE
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 TULANE AVE
Mailing Address - Street 2:SL 53
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2600
Mailing Address - Country:US
Mailing Address - Phone:504-988-0299
Mailing Address - Fax:504-988-0239
Practice Address - Street 1:1415 TULANE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2600
Practice Address - Country:US
Practice Address - Phone:504-988-2623
Practice Address - Fax:504-988-8886
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA78019-3420174400000X
LAAP03420364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1458465Medicaid
LA5Y2346677Medicare Oscar/Certification
LA1458465Medicaid