Healthcare Provider Details

I. General information

NPI: 1669684106
Provider Name (Legal Business Name): WOMENS HEALTH OF SOUTHWEST LOUISIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 NELSON RD STE B9
LAKE CHARLES LA
70605-4148
US

IV. Provider business mailing address

4150 NELSON RD STE A2
LAKE CHARLES LA
70605-4169
US

V. Phone/Fax

Practice location:
  • Phone: 337-477-7891
  • Fax: 337-477-2962
Mailing address:
  • Phone: 337-477-7891
  • Fax: 337-477-2962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DONNA G ROGERS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 337-477-7891