Provider Demographics
NPI:1518403419
Name:WEBSTER, JAMMIE MARIE
Entity Type:Individual
Prefix:
First Name:JAMMIE
Middle Name:MARIE
Last Name:WEBSTER
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 1:918 GASSEN ST
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-4316
Mailing Address - Country:US
Mailing Address - Phone:504-708-8548
Mailing Address - Fax:504-475-5861
Practice Address - Street 1:918 GASSEN ST
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4316
Practice Address - Country:US
Practice Address - Phone:504-708-8548
Practice Address - Fax:504-475-5861
Is Sole Proprietor?:No
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA005139215172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver