Healthcare Provider Details

I. General information

NPI: 1396046462
Provider Name (Legal Business Name): HSWL NEWORLEANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2010
Last Update Date: 11/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1790 SATURN ST
NEW ORLEANS LA
70129-2270
US

IV. Provider business mailing address

1790 SATURN ST
NEW ORLEANS LA
70129-2270
US

V. Phone/Fax

Practice location:
  • Phone: 504-253-4671
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRITTANY AMBER VANN
Title or Position: HS3
Credential:
Phone: 504-253-4671