Healthcare Provider Details

I. General information

NPI: 1013489533
Provider Name (Legal Business Name): WOMANS HOSPITAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9637 JEFFERSON HWY
BATON ROUGE LA
70809-2632
US

IV. Provider business mailing address

9637 JEFFERSON HWY
BATON ROUGE LA
70809-2632
US

V. Phone/Fax

Practice location:
  • Phone: 225-924-8300
  • Fax: 225-927-6951
Mailing address:
  • Phone: 225-924-8300
  • Fax: 225-927-6951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateNULL

VIII. Authorized Official

Name: TERI G FONTENOT
Title or Position: CEO & PRESIDENT
Credential:
Phone: 225-924-8104