Healthcare Provider Details

I. General information

NPI: 1124889423
Provider Name (Legal Business Name): LEILA S POLAND WYATT CPM, LM, MIDWIFE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81498 DALE DR
FOLSOM LA
70437-3017
US

IV. Provider business mailing address

3014 DAUPHINE ST STE A
NEW ORLEANS LA
70117-6755
US

V. Phone/Fax

Practice location:
  • Phone: 352-409-4222
  • Fax:
Mailing address:
  • Phone: 352-409-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: