MEDICARE: DISCIPLESHIP CONSULTANT REALTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305S00000X	Point of Service

General Provider Information

NPI Number	:	1497191035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISCIPLESHIP CONSULTANT REALTIONS

Provider Business Mailing Address
First Line	:	2005 AMES BLVD
Second Line	:	SUITE #B
City	:	MARRERO
State	:	LA
Zip	:	70072-4719
Country	:	US
Telephone Number	:	504-371-0556
Fax Number	:

Provider Business Practice Location Address
First Line	:	2005 AMES BLVD
Second Line	:	SUITE #B
City	:	MARRERO
State	:	LA
Zip	:	70072-4719
Country	:	US
Telephone Number	:	504-371-0556
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. VERTIS' AENISE JESSIE
Credential	:	OWNER/ FOUNDER
Telephone Number	:	504-371-0556

Provider Enumeration Date	:	05/21/2013
Last Update Date	:	05/21/2013

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