=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215396775
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEART 2 HEART CARE CLINIC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2016
-----------------------------------------------------
Last Update Date | 01/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1984 WOODDALE BLVD
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70806-1512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-803-9230
-----------------------------------------------------
Fax | 777-553-9638
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1984 WOODDALE BLVD
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70806-1512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-300-6116
-----------------------------------------------------
Fax | 877-755-3963
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | MS. SHETILA BURRELL
-----------------------------------------------------
Credential | NP
-----------------------------------------------------
Telephone | 225-300-6010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Nurse Practitioner
-----------------------------------------------------
License Number | AP007758
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------