Individual
LAURA ANN IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDN RD
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 221-8411
(318) 429-5724
Mailing address
4111 PINES RD, SHREVEPORT, LA 71119-7315
(318) 631-4109
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
884597
LA
Other
Enumeration date
03/10/2006
Last updated
07/12/2007
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