Healthcare Provider Details

I. General information

NPI: 1295808525
Provider Name (Legal Business Name): NORMA ELIZABETH WOLVERTON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3612 FLORIDA AVE
KENNER LA
70065-3436
US

IV. Provider business mailing address

103 GAIL DR
LA PLACE LA
70068-6478
US

V. Phone/Fax

Practice location:
  • Phone: 504-712-0700
  • Fax: 504-305-8258
Mailing address:
  • Phone: 504-712-0700
  • Fax: 504-305-8258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberLA1137
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: