Individual
ETHAN HORNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
3341 YOUREE DR STE 205, SHREVEPORT, LA 71105-2149
(318) 219-4167
Mailing address
5301 MEADOWSWEET CIR, BOSSIER CITY, LA 71112-8645
(318) 230-2270
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
20190021
LA
Other
Enumeration date
05/27/2021
Last updated
05/27/2021
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