MEDICARE: DR. MARCELLE GUNDLACH WAINER AUD

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
1	231H00000X	Audiologist		LA

General Provider Information

NPI Number	:	1720516107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARCELLE GUNDLACH WAINER AUD

Provider Business Mailing Address
First Line	:	4224 HOUMA BLVD STE 640
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70006-2939
Country	:	US
Telephone Number	:	504-456-5120
Fax Number	:

Provider Business Practice Location Address
First Line	:	4224 HOUMA BLVD STE 640
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70006-2939
Country	:	US
Telephone Number	:	504-456-5120
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2017
Last Update Date	:	07/21/2022

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