Provider Demographics
NPI:1639666332
Name:FAMILY HEALTH AND WELLNESS OF CHALMETTE, LLC
Entity Type:Organization
Organization Name:FAMILY HEALTH AND WELLNESS OF CHALMETTE, LLC
Other - Org Name:FAMILY HEALTH AND WELLNESS OF CHALMETTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LICCIARDI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:504-249-5187
Mailing Address - Street 1:410 W JUDGE PEREZ DR
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-4906
Mailing Address - Country:US
Mailing Address - Phone:504-249-5187
Mailing Address - Fax:504-304-9951
Practice Address - Street 1:410 W JUDGE PEREZ DR
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4906
Practice Address - Country:US
Practice Address - Phone:504-249-5187
Practice Address - Fax:504-304-9951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04945363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty