Healthcare Provider Details

I. General information

NPI: 1104338458
Provider Name (Legal Business Name): MONET WILTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2017
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 EDENBORN AVE STE 302
METAIRIE LA
70002
US

IV. Provider business mailing address

2637 EDENBORN AVE STE 302
METAIRIE LA
70002-7042
US

V. Phone/Fax

Practice location:
  • Phone: 504-455-2446
  • Fax: 504-455-7626
Mailing address:
  • Phone: 504-455-2446
  • Fax: 504-455-7626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: