Individual
BRANNON ELIZABETH WIEDEMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1542 TULANE AVE, NEW ORLEANS, LA 70112-2865
(504) 568-6004
Mailing address
2028 CAMP ST, NEW ORLEANS, LA 70130-5032
(985) 630-8838
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
MD.207587
LA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/20/2013
Last updated
05/08/2018
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