Provider Demographics
NPI:1982034591
Name:WARD, ANN
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:WARD
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:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71273-0698
Mailing Address - Country:US
Mailing Address - Phone:318-396-6789
Mailing Address - Fax:318-396-0321
Practice Address - Street 1:4900 CYPRESS ST
Practice Address - Street 2:SUITE 5
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-7670
Practice Address - Country:US
Practice Address - Phone:318-396-6789
Practice Address - Fax:318-396-0321
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
1192910002Medicare NSC