Provider Demographics
NPI:1730657883
Name:BONNE FETE MATERNITY
Entity Type:Organization
Organization Name:BONNE FETE MATERNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MIDWIFE
Authorized Official - Prefix:MS
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:LEIGHANN
Authorized Official - Last Name:WESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPM
Authorized Official - Phone:318-828-2693
Mailing Address - Street 1:809 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-2113
Mailing Address - Country:US
Mailing Address - Phone:318-834-4857
Mailing Address - Fax:318-383-6378
Practice Address - Street 1:809 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2113
Practice Address - Country:US
Practice Address - Phone:318-834-4857
Practice Address - Fax:318-383-6378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-07
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing