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NPI Code Detail

MEDICARE: TAWANA WAYNE

MEDICARE: TAWANA WAYNE
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
1171M00000XCase Manager/Care Coordinator

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780326462
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAWANA WAYNE
Provider Business Mailing Address
First Line : 1000 CHINABERRY DR STE 900
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71111-2455
Country : US
Telephone Number : 318-202-3706
Fax Number :
Provider Business Practice Location Address
First Line : 305 E MISSISSIPPI AVE STE 1
Second Line :
City : RUSTON
State : LA
Zip : 71270-3905
Country : US
Telephone Number : 318-202-3706
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2022
Last Update Date : 03/11/2026

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Directions to “ TAWANA WAYNE ” Practice Location

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