Individual
LISA DESHUN SMART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2913 BETIN AVE, MONROE, LA 71201-7257
(318) 388-1250
Mailing address
4 LESLIE LN, MONROE, LA 71203-2715
(318) 791-0359
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
09612
LA
363LF0000X
Family Nurse Practitioner
Primary
AP09612
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2466186
—
LA
01
—
AP09612
APRN
LA
Enumeration date
12/19/2017
Last updated
06/11/2019
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