Individual
BRENDA LAVON NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6811 FAIRFIELD AVE, SHREVEPORT, LA 71106-3803
(318) 216-5088
Mailing address
6811 FAIRFIELD AVE, SHREVEPORT, LA 71106-3803
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/19/2021
Last updated
07/19/2021
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