Healthcare Provider Details

I. General information

NPI: 1518516285
Provider Name (Legal Business Name): MRS. WINNIE WILMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641 KNIGHT DR
NEW ORLEANS LA
70127-3327
US

IV. Provider business mailing address

4641 KNIGHT DR
NEW ORLEANS LA
70127-3327
US

V. Phone/Fax

Practice location:
  • Phone: 504-242-5071
  • Fax:
Mailing address:
  • Phone: 504-242-5071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: