Provider Demographics
NPI:1699709873
Name:MABERRY, RHONDA (NP)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:MABERRY
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 1:7900 LAFOURCHE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-1442
Mailing Address - Country:US
Mailing Address - Phone:504-810-7460
Mailing Address - Fax:504-891-1805
Practice Address - Street 1:7900 LAFOURCHE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-1442
Practice Address - Country:US
Practice Address - Phone:504-810-7460
Practice Address - Fax:504-891-1805
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO3876363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11057Medicaid
LAP43057Medicare UPIN
LA4B991Medicare ID - Type Unspecified