Individual
MELANIE G. PETCHAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-BC
Contact information
Practice address
7611 SAINT VINCENT AVE, SHREVEPORT, LA 71106-4231
(318) 861-1671
Mailing address
1 SAINT MARY PL, SHREVEPORT, LA 71101-4343
(318) 861-1671
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APO3820
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1166430
—
LA
Enumeration date
04/13/2007
Last updated
11/19/2024
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