Individual
MOLLY HENDERSON MARANTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2539 VIKING DR STE 101, BOSSIER CITY, LA 71111-2165
(318) 747-8100
(318) 747-8150
Mailing address
2539 VIKING DR STE 101, BOSSIER CITY, LA 71111-2165
(318) 747-8100
(318) 747-8150
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
20017
LA
363A00000X
Physician Assistant
Primary
20017
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1627739
—
LA
Enumeration date
07/09/2006
Last updated
10/28/2020
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