Provider Demographics
NPI:1346665221
Name:FLEUR DE LIS FIRST ASSIST LLC
Entity Type:Organization
Organization Name:FLEUR DE LIS FIRST ASSIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA/CST
Authorized Official - Phone:985-373-0717
Mailing Address - Street 1:103 CARMEL DR
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-4128
Mailing Address - Country:US
Mailing Address - Phone:985-373-0717
Mailing Address - Fax:985-727-3259
Practice Address - Street 1:103 CARMEL DR
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-4128
Practice Address - Country:US
Practice Address - Phone:985-373-0717
Practice Address - Fax:985-727-3259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
145863OtherNATIONAL CSFA CERTIFICATE#