Individual
MRS. CARISSA M COLLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4800 S GRAND ST, MONROE, LA 71202-6412
(318) 362-3339
(318) 362-4174
Mailing address
4800 S GRAND ST, MONROE, LA 71202-6412
(318) 362-3339
(318) 362-4174
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
990718
LA
Other
Enumeration date
02/05/2007
Last updated
07/08/2007
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