Provider Demographics
NPI:1427490275
Name:SUBERVIELLE, STEPHANIE ANN (NP-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:SUBERVIELLE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 BEHRMAN PL
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70114-8216
Mailing Address - Country:US
Mailing Address - Phone:504-371-9323
Mailing Address - Fax:
Practice Address - Street 1:3401 BEHRMAN PL
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114-8216
Practice Address - Country:US
Practice Address - Phone:504-371-9323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07331363LF0000X
LARN122832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily