Provider Demographics
NPI:1346832359
Name:MAGNOLIA BARK WOUND CARE SOLUTIONS L.L.C.
Entity Type:Organization
Organization Name:MAGNOLIA BARK WOUND CARE SOLUTIONS L.L.C.
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEACHEL
Authorized Official - Middle Name:COOK
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:504-875-6629
Mailing Address - Street 1:10001 LAKE FOREST BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-6204
Mailing Address - Country:US
Mailing Address - Phone:504-265-9044
Mailing Address - Fax:
Practice Address - Street 1:10001 LAKE FOREST BLVD STE 201
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-6204
Practice Address - Country:US
Practice Address - Phone:504-265-9044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty