Organization
EXOTIC EXPRESSIONS INC.
Active
Organization
EXOTIC EXPRESSIONS INC.
Active
Other names
SHANA MADALYN WILTZ
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHANA MADALYN WILTZ LICENSED (CEO)
(337) 376-0473
Entity
Organization
Contact information
Practice address
729 CECILE BLVD, BREAUX BRIDGE, LA 70517-5707
(337) 376-0473
Mailing address
729 CECILE BLVD, BLDG A- 1, BREAUX BRIDGE, LA 70517-5707
(337) 376-0473
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
11041986
LA
Other
Enumeration date
01/24/2017
Last updated
01/24/2017
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