Individual
IKEA DARBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2210 LINE AVE, SHREVEPORT, LA 71104-2152
(318) 675-1112
Mailing address
2210 LINE AVE STE 207, SHREVEPORT, LA 71104-2134
(318) 675-1112
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
LA
Other
Enumeration date
01/10/2023
Last updated
01/10/2023
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