Individual
MARILYN NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3341 YOUREE DR, SHREVEPORT, LA 71105-2149
(318) 219-4167
Mailing address
4222 RIDGEWAY ST, SHREVEPORT, LA 71107-7634
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
810346
LA
Other
Enumeration date
09/08/2016
Last updated
09/08/2016
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