Individual
MISS MATILDA ELLIOTT STEPHENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3400 MEDICAL PARK DR STE B, MONROE, LA 71203-2300
(318) 387-6803
(318) 387-6874
Mailing address
130 DESIARD ST STE 355, MONROE, LA 71201-7363
(318) 807-7875
(318) 812-6603
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APO4970
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1458449
—
LA
Enumeration date
10/21/2006
Last updated
06/13/2019
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