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General NPI Number Information
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NPI Number | 1154652618
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Entity Type | Organization
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Legal Business Name | ADVANCED DERMATOLOGY & FAMILY HEALTH CARE WALK-IN & WELLNESS CLINICLLC
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Dates
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Enumeration Date | 01/22/2010
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Last Update Date | 08/31/2010
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Provider Practice Location Address
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Address Line | 3295 E CAUSEWAY APPROACH
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City | MANDEVILLE
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State | LA
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Zip | 70448-3451
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Country | US
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Telephone | 985-674-1481
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Fax | 985-626-6956
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Provider Business Mailing Address
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Address Line | 3295 E CAUSEWAY APPROACH
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City | MANDEVILLE
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State | LA
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Zip | 70448-3451
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Country | US
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Telephone | 985-674-1481
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Fax | 985-626-6956
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Authorized Official
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Title or Position | ADULT NURSE PRACTITIONER/CEO
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Name | MELISSA M BROWN
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Credential | ANP-C
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Telephone | 985-674-4015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP05770
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License Number State | LA
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