Individual
MISS KATHERINE LOUISE WYNNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
110 FONTAINBLEAU DR, MANDEVILLE, LA 70471-6419
(504) 458-4315
Mailing address
110 FONTAINBLEAU DR, MANDEVILLE, LA 70471-6419
(504) 458-4315
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
LA
Other
Enumeration date
08/18/2015
Last updated
08/18/2015
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