Provider Demographics
NPI:1295808525
Name:WOLVERTON, NORMA ELIZABETH (LMT)
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:ELIZABETH
Last Name:WOLVERTON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 GAIL DR
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-6478
Mailing Address - Country:US
Mailing Address - Phone:504-712-0700
Mailing Address - Fax:504-305-8258
Practice Address - Street 1:3612 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3436
Practice Address - Country:US
Practice Address - Phone:504-712-0700
Practice Address - Fax:504-305-8258
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA1137171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor