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General NPI Number Information
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NPI Number | 1942585591
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Entity Type | Organization
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Legal Business Name | IPH, SLIDEL LLC
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Dates
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Enumeration Date | 10/14/2011
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Last Update Date | 10/21/2011
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Provider Practice Location Address
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Address Line | 2364 GAUSE BLVD E STE 101
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City | SLIDELL
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State | LA
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Zip | 70461-4141
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Country | US
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Telephone | 985-641-2202
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Fax | 985-641-2888
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Provider Business Mailing Address
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Address Line | 501 MARSHALL ST SUITE 607B
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City | JACKSON
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State | MS
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Zip | 39202-1651
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Country | US
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Telephone | 601-948-6540
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Fax | 601-948-6544
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Authorized Official
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Title or Position | MEMBER/MEDICAL DIRECTOR
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Name | MARIE J WILLIAMS
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Credential |
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Telephone | 985-641-2202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number |
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License Number State |
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