Individual
JEAN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1440 HAWN AVE, SHREVEPORT, LA 71107-6532
(318) 226-5990
Mailing address
1440 HAWN AVE, SHREVEPORT, LA 71107-6532
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
20160859
LA
Other
Enumeration date
02/01/2017
Last updated
02/01/2017
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