Individual
SHANE LOUIS PENNISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN, FNP-C
Contact information
Practice address
431 W LAFAYETTE ST, WINNFIELD, LA 71483-3463
(318) 648-0375
Mailing address
PO BOX 68, DRY PRONG, LA 71423-0068
(318) 447-5305
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
225854
LA
Other
Enumeration date
06/16/2022
Last updated
06/16/2022
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