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NPI Code Detail

MEDICARE: NEW BEGINNINGS WELLNESS CENTER AND SPA, LLC

MEDICARE: NEW BEGINNINGS WELLNESS CENTER AND SPA, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208D00000XGeneral Practice PhysicianAP06950LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AP06950OTHERLANURSE PRACTITIONER
2PA021491OTHERLAPRESCRIPTIVE AUTHORITY

General Provider Information

NPI Number : 1033552047
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEW BEGINNINGS WELLNESS CENTER AND SPA, LLC
Provider Business Mailing Address
First Line : 1809 NORTHPOINTE LANE
Second Line : SUITE 202
City : RUSTON
State : LA
Zip : 71270-3852
Country : US
Telephone Number : 318-255-1155
Fax Number : 318-255-3181
Provider Business Practice Location Address
First Line : 1809 NORTHPOINTE AVE.
Second Line : SUITE 202
City : RUSTON
State : LA
Zip : 71270-3852
Country : US
Telephone Number : 318-255-1155
Fax Number : 318-255-3181
Authorized Official
Title or Position : OWNER
Name : MRS. LUCY DOUGLAS
Credential : NP
Telephone Number : 318-255-1155
Provider Enumeration Date : 04/09/2013
Last Update Date : 04/09/2013

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Directions to “NEW BEGINNINGS WELLNESS CENTER AND SPA, LLC ” Practice Location

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