Individual
JENNIFER WOERNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD, MD
Contact information
Practice address
1501 KINGS HWY, DEPARTMENT OF ORAL SURGERY, SHREVEPORT, LA 71103-4228
(318) 675-4881
(318) 675-5069
Mailing address
1501 KINGS HWY, ATTN: LEISA OGLESBY (RM. 1-201), SHREVEPORT, LA 71103-4228
(318) 675-4881
(318) 675-5069
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
205899
LA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
S-483
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1507458
—
LA
01
—
292492YH54
MEDICARE - PTAN
LA
Enumeration date
05/30/2007
Last updated
12/27/2016
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