Individual
CALISHA FORTNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
350 DESIARD PLAZA DR STE 217, MONROE, LA 71203-4959
(318) 512-9452
Mailing address
350 DESIARD PLAZA DR STE 217, MONROE, LA 71203-4959
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
05/09/2019
Last updated
10/20/2023
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