Healthcare Provider Details

I. General information

NPI: 1669906251
Provider Name (Legal Business Name): DIEDRA BREWER-HOHENSEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FLORIDA AVE
NEW ORLEANS LA
70119-2715
US

IV. Provider business mailing address

1532 STELLA PL
MARRERO LA
70072-3634
US

V. Phone/Fax

Practice location:
  • Phone: 504-941-8148
  • Fax: 504-941-8154
Mailing address:
  • Phone: 504-941-8148
  • Fax: 504-941-8154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number3258
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: