Provider Demographics
NPI:1710100888
Name:BARZE, GWENDOLYN (HOME CARE PROVIDER)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:
Last Name:BARZE
Suffix:
Gender:F
Credentials:HOME CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2245 MANHATTAN BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-3580
Mailing Address - Country:US
Mailing Address - Phone:504-368-5937
Mailing Address - Fax:504-366-0718
Practice Address - Street 1:2245 MANHATTAN BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-3580
Practice Address - Country:US
Practice Address - Phone:504-368-5937
Practice Address - Fax:504-366-0718
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12053305R00000X
LA12054305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA56-2497257Medicaid