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General NPI Number Information
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NPI Number | 1639666332
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Entity Type | Organization
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Legal Business Name | FAMILY HEALTH AND WELLNESS OF CHALMETTE, LLC
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Dates
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Enumeration Date | 04/18/2018
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Last Update Date | 04/18/2018
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Provider Practice Location Address
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Address Line | 410 W JUDGE PEREZ DR
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City | CHALMETTE
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State | LA
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Zip | 70043-4906
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Country | US
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Telephone | 504-249-5187
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Fax | 504-304-9951
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Provider Business Mailing Address
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Address Line | 410 W JUDGE PEREZ DR
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City | CHALMETTE
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State | LA
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Zip | 70043-4906
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Country | US
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Telephone | 504-249-5187
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Fax | 504-304-9951
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Authorized Official
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Title or Position | PRINCIPAL OWNER
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Name | PAULA LICCIARDI
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Credential | APRN
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Telephone | 504-249-5187
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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 | AP04945
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License Number State | LA
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