Provider Demographics
NPI:1154138014
Name:BORROUSO, LINDSEY MARIANA
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MARIANA
Last Name:BORROUSO
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 1:314 ATHERTON DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-3808
Mailing Address - Country:US
Mailing Address - Phone:504-232-7554
Mailing Address - Fax:
Practice Address - Street 1:314 ATHERTON DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-3808
Practice Address - Country:US
Practice Address - Phone:504-232-7554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-14
Last Update Date:2024-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA210484390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty