1770586323 NPI number — DR. MARI JESSICA WIRFS MN, PHD, BCFNP

Table of content: DR. MARI JESSICA WIRFS MN, PHD, BCFNP (NPI 1770586323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770586323 NPI number — DR. MARI JESSICA WIRFS MN, PHD, BCFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIRFS
Provider First Name:
MARI
Provider Middle Name:
JESSICA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MN, PHD, BCFNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770586323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8840 WESTGATE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70003-5452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-467-5540
Provider Business Mailing Address Fax Number:
504-816-8596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3939 GENTILLY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ORLEANS
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70126-4858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-816-8596
Provider Business Practice Location Address Fax Number:
504-816-8452
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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