1295808525 NPI number — NORMA ELIZABETH WOLVERTON LMT

Table of content: (NPI 1871505248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295808525 NPI number — NORMA ELIZABETH WOLVERTON LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOLVERTON
Provider First Name:
NORMA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMT
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:
1295808525
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:
103 GAIL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA PLACE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70068-6478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-712-0700
Provider Business Mailing Address Fax Number:
504-305-8258

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3612 FLORIDA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70065-3436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-712-0700
Provider Business Practice Location Address Fax Number:
504-305-8258
Provider Enumeration Date:
11/16/2006

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: 171W00000X , with the licence number:  LA1137 , 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)





Copyright © 2007-2025 www.npivalidator.com