Individual
MARILYN GLOVER LATIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 990-4041
Mailing address
354 DIANE LN, STONEWALL, LA 71078-9653
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP10019
LA
Other
Enumeration date
08/20/2018
Last updated
08/20/2018
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