Organization
NORTHLAKE MEDICINE AND WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TANIA ANN LEVI M.D. (OWNER)
(985) 809-6195
Entity
Organization
Contact information
Practice address
1980 N HIGHWAY 190, COVINGTON, LA 70433-5158
(985) 809-6195
(985) 809-6199
Mailing address
1980 N HIGHWAY 190, COVINGTON, LA 70433-5158
(985) 809-6195
(985) 809-6199
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
018251
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1378054
—
LA
Enumeration date
10/16/2006
Last updated
08/16/2010
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