Provider Demographics
NPI:1528518818
Name:B&B WOUND CARE CONSULTANT
Entity type:Organization
Organization Name:B&B WOUND CARE CONSULTANT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN,WCC
Authorized Official - Phone:337-680-0001
Mailing Address - Street 1:2519 PALMETO DR
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2926
Mailing Address - Country:US
Mailing Address - Phone:337-680-0001
Mailing Address - Fax:
Practice Address - Street 1:2519 PALMETO DR
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2926
Practice Address - Country:US
Practice Address - Phone:337-680-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN089327163W00000X
LA4260923163WW0000X
LA7280825163WW0000X
LARN141609163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty