Provider Demographics
NPI:1427290840
Name:PRATTINI, MICHELE A (NP)
Entity type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:A
Last Name:PRATTINI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3733 BARBARA PL
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-5805
Mailing Address - Country:US
Mailing Address - Phone:504-457-3687
Mailing Address - Fax:504-620-0250
Practice Address - Street 1:4409 UTICA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6530
Practice Address - Country:US
Practice Address - Phone:504-457-3687
Practice Address - Fax:504-620-0250
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN075498-AP05744363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LARN075498-AP05744OtherNP LICENSE
LA1946095Medicaid
LA1486442Medicaid
LA1486442Medicaid
LA1946095Medicaid
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