Individual
EDITH NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1543 GRIMMETT DR, SHREVEPORT, LA 71107-6505
(318) 626-5597
Mailing address
1543 GRIMMETT DR, SHREVEPORT, LA 71107-6505
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/11/2020
Last updated
03/11/2020
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