Provider Demographics
NPI:1477632693
Name:WEYDERT, AMBER PLAISANCE (PA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:PLAISANCE
Last Name:WEYDERT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MARIE
Other - Last Name:PLAISANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1032 PARC HELENE DR
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-2451
Mailing Address - Country:US
Mailing Address - Phone:504-347-7578
Mailing Address - Fax:
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:5TH FLOOR CLINIC TOWER
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2429
Practice Address - Country:US
Practice Address - Phone:504-842-4070
Practice Address - Fax:504-842-2090
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200111363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical