Individual
CEONNA DIANE WAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1519 CRESWELL AVE, SHREVEPORT, LA 71101-4774
(318) 869-1899
Mailing address
1110 CAREY AVE, RUSTON, LA 71270-4828
(318) 558-1679
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
07/06/2022
Last updated
07/06/2022
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