Provider Demographics
NPI:1417221953
Name:COUSIN, WENDELL
Entity Type:Individual
Prefix:
First Name:WENDELL
Middle Name:
Last Name:COUSIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 CANAL ST STE 210
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6069
Mailing Address - Country:US
Mailing Address - Phone:504-483-1985
Mailing Address - Fax:504-483-1984
Practice Address - Street 1:3801 CANAL ST STE 210
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6069
Practice Address - Country:US
Practice Address - Phone:504-483-1985
Practice Address - Fax:504-483-1984
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker