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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