Provider Demographics
NPI:1386157535
Name:CHADWELL, NICOLETTE QUINN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:NICOLETTE
Middle Name:QUINN
Last Name:CHADWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:NICOLETTE
Other - Middle Name:ASHLEY
Other - Last Name:QUINN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:826 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-3147
Mailing Address - Country:US
Mailing Address - Phone:504-309-7108
Mailing Address - Fax:
Practice Address - Street 1:826 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-3147
Practice Address - Country:US
Practice Address - Phone:504-309-7108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-09
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA307201363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant