Healthcare Provider Details
I. General information
NPI: 1154067155
Provider Name (Legal Business Name): WELLNESS INSTITUTE OF NEPHROLOGY, LLC (WIN)
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/11/2022
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:
III. Provider practice location address
200 W ESPLANADE AVE STE 305
KENNER LA
70065-2474
US
IV. Provider business mailing address
26 PLATT ST
KENNER LA
70065-1065
US
V. Phone/Fax
- Phone: 504-464-8712
- Fax: 504-464-8711
- Phone: 504-939-3640
- Fax: 504-469-7138
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RN0300X |
| Taxonomy | Nephrology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
MALIKA
MORSE
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 504-939-3640