Provider Demographics
NPI:1275171878
Name:NETTLES, WILMA CARMELA
Entity Type:Individual
Prefix:MS
First Name:WILMA
Middle Name:CARMELA
Last Name:NETTLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5630 CROWDER BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-2429
Mailing Address - Country:US
Mailing Address - Phone:504-241-6006
Mailing Address - Fax:504-241-6007
Practice Address - Street 1:5630 CROWDER BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-2429
Practice Address - Country:US
Practice Address - Phone:504-241-6006
Practice Address - Fax:504-241-6006
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator