Individual
COMIS WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 221-8411
Mailing address
3925 LE BROOKE LN, BENTON, LA 71006-9726
(318) 507-6249
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
208329
LA
Other
Enumeration date
10/21/2019
Last updated
10/21/2019
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