Provider Demographics
NPI:1164921177
Name:WESSLER, JAIME L (CPM, LM)
Entity Type:Individual
Prefix:MS
First Name:JAIME
Middle Name:L
Last Name:WESSLER
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 RATCLIFF ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-4812
Mailing Address - Country:US
Mailing Address - Phone:318-834-4857
Mailing Address - Fax:
Practice Address - Street 1:809 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2113
Practice Address - Country:US
Practice Address - Phone:318-828-2693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-05
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA308038176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife