Organization Name: | WELLNESS CENTER FOR SKIN THERAPY LLC |
NPI Number: | 1053705574 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JENNIFER BURNS NORWOOD (OWNER) |
Mailing Address: | 2751 Albert L Bicknell Dr Suite 1a Shreveport |
State: | LA US |
Postal Code: | 711033920 |
Phone Number: | 3182212821 |
Fax Number: | |
NPI Enumeration Date: | 03/23/2015 |
NPI Last Update Date: | 03/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | AP03173 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |