Healthcare Provider Details

I. General information

NPI: 1093523664
Provider Name (Legal Business Name): TOTAL WELLNESS CARE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2024
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 N 7TH ST
MONROE LA
71201-6352
US

IV. Provider business mailing address

700 N 7TH ST
MONROE LA
71201-6352
US

V. Phone/Fax

Practice location:
  • Phone: 318-598-5040
  • Fax: 318-515-0011
Mailing address:
  • Phone: 318-598-5040
  • Fax: 318-515-0011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: EDWARD LANIER
Title or Position: ADMINISTRATOR
Credential:
Phone: 817-602-4389