Provider Demographics
NPI:1588112452
Name:WELLS TAYLOR, IESHA
Entity type:Individual
Prefix:
First Name:IESHA
Middle Name:
Last Name:WELLS TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 CAMBRIDGE DR
Mailing Address - Street 2:SUITE 103A
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-3646
Mailing Address - Country:US
Mailing Address - Phone:504-418-5435
Mailing Address - Fax:
Practice Address - Street 1:948 CAMBRIDGE DR
Practice Address - Street 2:SUITE 103A
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-3646
Practice Address - Country:US
Practice Address - Phone:504-418-5435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health