Provider Demographics
NPI:1427050822
Name:NICOLETTI, LISA H (DNP, APRN, FNP-BC)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:H
Last Name:NICOLETTI
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 RUBICH LN
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-1362
Mailing Address - Country:US
Mailing Address - Phone:985-640-9422
Mailing Address - Fax:
Practice Address - Street 1:510 E STONER AVE # 5N19
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4243
Practice Address - Country:US
Practice Address - Phone:318-221-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR869017363LF0000X
LARN073931-AP03946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11254Medicaid
LA4C117C842Medicare PIN
LA11254Medicaid
P00436032Medicare PIN