Individual
BENJAMIN R. WISENBAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
(318) 629-4833
Mailing address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
28217287A
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
AP07907
LA
Other
Enumeration date
07/07/2014
Last updated
10/10/2024
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