Individual
MRS. ANNIE WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3113 MOORE STATION RD, SHREVEPORT, LA 71108-5043
(318) 423-4561
(318) 848-7713
Mailing address
3113 MOORE STATION RD, SHREVEPORT, LA 71108-5043
(318) 423-4561
(318) 848-7713
Taxonomy
Speciality
Code
Description
License number
State
171WV0202X
Vehicle Modifications Contractor
Primary
002803974
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
811916782
—
LA
Enumeration date
05/24/2016
Last updated
05/24/2016
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