Healthcare Provider Details

I. General information

NPI: 1346665221
Provider Name (Legal Business Name): FLEUR DE LIS FIRST ASSIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 02/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CARMEL DR
MANDEVILLE LA
70448-4128
US

IV. Provider business mailing address

103 CARMEL DR
MANDEVILLE LA
70448-4128
US

V. Phone/Fax

Practice location:
  • Phone: 985-373-0717
  • Fax: 985-727-3259
Mailing address:
  • Phone: 985-373-0717
  • Fax: 985-727-3259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: MRS. RACHEL N WELLS
Title or Position: PRESIDENT
Credential: CSFA/CST
Phone: 985-373-0717