Provider Demographics
NPI:1306455498
Name:HEADACHE CENTER NOLA, LLC
Entity type:Organization
Organization Name:HEADACHE CENTER NOLA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TREPPENDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC, AQH, MHD
Authorized Official - Phone:601-366-0855
Mailing Address - Street 1:PO BOX 3489
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39207-3489
Mailing Address - Country:US
Mailing Address - Phone:601-366-0855
Mailing Address - Fax:601-898-9833
Practice Address - Street 1:2221 CLEARVIEW PKWY STE 203
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-2497
Practice Address - Country:US
Practice Address - Phone:601-366-0855
Practice Address - Fax:601-898-9833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty