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General NPI Number Information
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NPI Number | 1629405477
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Entity Type | Organization
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Legal Business Name | SLIDELL FAMILY MEDICAL AND WELLNESS CARE, LLC
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Dates
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Enumeration Date | 10/10/2013
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Last Update Date | 02/03/2014
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Provider Practice Location Address
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Address Line | 1301 BROWNSWITCH RD SUITE C
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City | SLIDELL
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State | LA
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Zip | 70461-1695
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Country | US
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Telephone | 985-326-8011
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Fax | 985-326-8015
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Provider Business Mailing Address
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Address Line | 1375 CORPORATE SQUARE DR
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City | SLIDELL
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State | LA
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Zip | 70458-3147
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Country | US
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Telephone | 985-326-8011
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Fax | 985-326-8015
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MS. CHERYL L KREWSKY
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Credential | APRN
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Telephone | 985-326-8011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP05069
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License Number State | LA
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