Provider Demographics
NPI:1043041593
Name:MARCHESE, JAE EUN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:JAE EUN
Middle Name:
Last Name:MARCHESE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 LAPALCO BLVD STE 1B
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:605 LAPALCO BLVD # 1B
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7302
Practice Address - Country:US
Practice Address - Phone:504-371-9355
Practice Address - Fax:504-371-6557
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208845363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily