Provider Demographics
NPI:1538989215
Name:BIENVENUE HEALTH & WELLNESS
Entity type:Organization
Organization Name:BIENVENUE HEALTH & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:318-426-4064
Mailing Address - Street 1:708 FIR WOOD LN
Mailing Address - Street 2:
Mailing Address - City:HAUGHTON
Mailing Address - State:LA
Mailing Address - Zip Code:71037-8880
Mailing Address - Country:US
Mailing Address - Phone:318-426-4064
Mailing Address - Fax:
Practice Address - Street 1:228 SPRING ST.
Practice Address - Street 2:SUITE 110
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101
Practice Address - Country:US
Practice Address - Phone:318-225-6264
Practice Address - Fax:985-224-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service