Healthcare Provider Details

I. General information

NPI: 1104910066
Provider Name (Legal Business Name): MARIE SCHULTHEIS WYATT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE MARGARET SCHULTHEIS RN

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 CANAL ST
NEW ORLEANS LA
70119-6208
US

IV. Provider business mailing address

3434 CANAL ST
NEW ORLEANS LA
70119-6208
US

V. Phone/Fax

Practice location:
  • Phone: 504-507-5744
  • Fax:
Mailing address:
  • Phone: 504-507-5744
  • Fax: 405-456-7481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number099809
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN099809-AP05092
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: