Provider Demographics
NPI:1124889423
Name:POLAND WYATT, LEILA S (CPM, LM, MIDWIFE)
Entity type:Individual
Prefix:
First Name:LEILA
Middle Name:S
Last Name:POLAND WYATT
Suffix:
Gender:F
Credentials:CPM, LM, MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 DAUPHINE ST STE A
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70117-6755
Mailing Address - Country:US
Mailing Address - Phone:352-409-4222
Mailing Address - Fax:
Practice Address - Street 1:81498 DALE DR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:LA
Practice Address - Zip Code:70437-3017
Practice Address - Country:US
Practice Address - Phone:352-409-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-23
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife