Healthcare Provider Details

I. General information

NPI: 1487010096
Provider Name (Legal Business Name): LAISSE ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 07/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 LANTANA DR
HOCKESSIN DE
19707-8813
US

IV. Provider business mailing address

502 LANTANA DR
HOCKESSIN DE
19707-8813
US

V. Phone/Fax

Practice location:
  • Phone: 302-763-3455
  • Fax:
Mailing address:
  • Phone: 302-763-3455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. STEWART MARTIN WIGGINS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 609-929-7842