Individual
CAMILLE THEISEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1500 LINE AVE, SHREVEPORT, LA 71101-4639
(318) 213-3800
Mailing address
3170 FM 21, PITTSBURG, TX 75686-7662
(775) 336-7269
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
918652
TX
Other
Enumeration date
10/17/2023
Last updated
10/17/2023
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