Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 308038 | LA |
NPI | 1164921177 |
---|---|
Provider Name | Ms. Jaime L Wessler |
First Address | Shreveport, LA 71104-4812 |
Second Address | Shreveport, LA 71104-2113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2018 |
Last Update Date | 27/01/2020 |