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General NPI Number Information
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NPI Number | 1487010096
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Entity Type | Organization
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Legal Business Name | LAISSE ENTERPRISES INC
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 07/13/2016
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Provider Practice Location Address
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Address Line | 502 LANTANA DR
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City | HOCKESSIN
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State | DE
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Zip | 19707-8813
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Country | US
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Telephone | 302-763-3455
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Fax |
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Provider Business Mailing Address
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Address Line | 502 LANTANA DR
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City | HOCKESSIN
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State | DE
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Zip | 19707-8813
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Country | US
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Telephone | 302-763-3455
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. STEWART MARTIN WIGGINS
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Credential |
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Telephone | 609-929-7842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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