1215444625 NPI number — MICHELLE L WALL, LLC

Table of content: (NPI 1215444625)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215444625 NPI number — MICHELLE L WALL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHELLE L WALL, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ABC CASE MANAGEMENT
Provider Other Organization Name Type Code:
3
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:
1215444625
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1284
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENHAM SPRINGS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70727-1284
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 SEVERN AVE STE 22A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70002-3481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-520-8545
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WALL
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
225-667-4014

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  27044 , 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)