Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 205899 | LA |
N | 204E00000X | Oral & Maxillofacial Surgeon | S-483 | LA |
NPI | 1255532842 |
---|---|
Provider Name | Jennifer Woerner |
First Address | Shreveport, LA 71103-4228 |
Second Address | Shreveport, LA 71103-4228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 27/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1507458 | (05) | LA |
292492YH54 | MEDICARE - PTAN (01) | LA |