MEDICARE: DR. MARI JESSICA WIRFS MN, PHD, BCFNP

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	363LF0000X	Family Nurse Practitioner		LA

General Provider Information

NPI Number	:	1770586323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARI JESSICA WIRFS MN, PHD, BCFNP

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

Provider Business Practice Location Address
First Line	:	3939 GENTILLY BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70126-4858
Country	:	US
Telephone Number	:	504-816-8596
Fax Number	:	504-816-8452

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/08/2007

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