Provider Demographics
NPI:1750563771
Name:ACADIANA WOUND CARE SPECIALIST, LLC
Entity type:Organization
Organization Name:ACADIANA WOUND CARE SPECIALIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVILLIER
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN,CWOCN
Authorized Official - Phone:888-669-6863
Mailing Address - Street 1:PO BOX 53888
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-3888
Mailing Address - Country:US
Mailing Address - Phone:888-669-6863
Mailing Address - Fax:888-456-9223
Practice Address - Street 1:6948 VETERANS MEMORIAL HWY.
Practice Address - Street 2:
Practice Address - City:MAMOU
Practice Address - State:LA
Practice Address - Zip Code:70554-4823
Practice Address - Country:US
Practice Address - Phone:888-669-6863
Practice Address - Fax:888-456-9223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN059946302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization