Individual
COREEN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4401 WILDWOOD DR, SHREVEPORT, LA 71119-8611
(318) 210-5187
Mailing address
4401 WILDWOOD DR, SHREVEPORT, LA 71119-8611
(318) 210-5187
Taxonomy
Speciality
Code
Description
License number
State
347E00000X
Transportation Broker
Primary
—
—
Other
Enumeration date
03/12/2021
Last updated
03/12/2021
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