Individual
MALCOLM A MCMILLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
255 BERT KOUNS LOOP, SHREVEPORT, LA 71106-8150
(318) 683-0411
(318) 603-5461
Mailing address
PO BOX 6270, SHREVEPORT, LA 71136-6270
(318) 683-0411
(318) 603-5461
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN078292
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1428442
—
LA
Enumeration date
06/20/2005
Last updated
05/24/2013
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