Healthcare Provider Details

I. General information

NPI: 1023567468
Provider Name (Legal Business Name): ANTHONY WOODS RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2016
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 HOUMA BLVD #304
METAIRIE LA
70006-2940
US

IV. Provider business mailing address

4315 HOUMA BLVD #304
METAIRIE LA
70006-2940
US

V. Phone/Fax

Practice location:
  • Phone: 504-207-2222
  • Fax: 504-885-0080
Mailing address:
  • Phone: 504-207-2222
  • Fax: 504-885-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number120888
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: