Individual
SCHWONNA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3820 CROSBY ST, SHREVEPORT, LA 71109-8014
(318) 762-1395
Mailing address
3820 CROSBY ST, SHREVEPORT, LA 71109-8014
(318) 762-1395
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
LA
Other
Enumeration date
09/23/2019
Last updated
09/23/2019
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