Provider Demographics
NPI:1013313774
Name:PREMIER HEALTH & WELLNESS GROUP, LLC
Entity Type:Organization
Organization Name:PREMIER HEALTH & WELLNESS GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CFNP
Authorized Official - Prefix:
Authorized Official - First Name:LANNIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:PINO
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:225-673-4900
Mailing Address - Street 1:17188 AIRLINE HWY STE D
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-3443
Mailing Address - Country:US
Mailing Address - Phone:225-673-4900
Mailing Address - Fax:225-673-3338
Practice Address - Street 1:17188 AIRLINE HWY STE D
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-3443
Practice Address - Country:US
Practice Address - Phone:225-673-4900
Practice Address - Fax:225-673-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04341363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1460508Medicaid
LAQ25080Medicare UPIN
LA1460508Medicaid