Individual
ETOIL RAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1440 HAWN AVE, SHREVEPORT, LA 71107-6532
(318) 226-5990
(318) 226-5994
Mailing address
1440 HAWN AVE, SHREVEPORT, LA 71107-6532
(318) 226-5990
(318) 226-5994
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN031863
LA
Other
Enumeration date
09/03/2015
Last updated
09/03/2015
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