Individual
MR. LANE S CARLISLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 990-4770
Mailing address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 990-4770
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
110585
LA
Other
Enumeration date
08/02/2013
Last updated
08/02/2013
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