| NPI | 1891231353 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRESA WALLACE Owner 504-309-2576 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: LA AP07277) |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2017-03-09 |