Individual
SUMMER WOLF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1515 RIVER RD, JEFFERSON, LA 70121-4227
(866) 624-7637
Mailing address
9909 JOEL AVE, RIVER RIDGE, LA 70123-1509
(504) 905-0058
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
213375
LA
363L00000X
Nurse Practitioner
908307
MS
Other
Enumeration date
03/17/2025
Last updated
04/24/2026
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