Individual
DEANERE JOHNSON SHELTON X
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
109 SPARROW RD, COLFAX, LA 71417-4104
(318) 277-6369
Mailing address
109 SPARROW RD, COLFAX, LA 71417-4104
(318) 277-6369
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
SZR190
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
343900000X
—
LA
Enumeration date
01/08/2015
Last updated
01/08/2015
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