Provider Demographics
NPI:1801259429
Name:NOLA PIN GIRLS LLC
Entity type:Organization
Organization Name:NOLA PIN GIRLS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WISMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-641-9494
Mailing Address - Street 1:1189 FREMAUX AVE
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-3537
Mailing Address - Country:US
Mailing Address - Phone:985-641-9479
Mailing Address - Fax:985-646-3456
Practice Address - Street 1:1189 FREMAUX AVE
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-3537
Practice Address - Country:US
Practice Address - Phone:985-641-9479
Practice Address - Fax:985-646-3456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)