Provider Demographics
NPI:1740541200
Name:WOUND TEAM
Entity type:Organization
Organization Name:WOUND TEAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LOCKLER
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:504-919-7511
Mailing Address - Street 1:PO BOX 688
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037-0688
Mailing Address - Country:US
Mailing Address - Phone:504-919-7511
Mailing Address - Fax:504-656-2865
Practice Address - Street 1:636 LOBDELL AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6318
Practice Address - Country:US
Practice Address - Phone:504-919-7511
Practice Address - Fax:504-656-2865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04755363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty