Provider Demographics
NPI:1255828398
Name:PRIMARY CARE & WELLNESS
Entity Type:Organization
Organization Name:PRIMARY CARE & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LABOSTRIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-490-0304
Mailing Address - Street 1:PO BOX 872713
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70187-2713
Mailing Address - Country:US
Mailing Address - Phone:404-490-0304
Mailing Address - Fax:504-241-0106
Practice Address - Street 1:9954 LAKE FOREST BLVD STE 10
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-2647
Practice Address - Country:US
Practice Address - Phone:504-241-0105
Practice Address - Fax:504-241-0106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-14
Last Update Date:2018-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09804363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty