Individual
LAWONDA 71118 RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9511 OVERLOOK DR, SHREVEPORT, LA 71118-4118
(318) 200-7305
Mailing address
9511 OVERLOOK DR, SHREVEPORT, LA 71118-4118
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
10/06/2022
Last updated
10/06/2022
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