Individual
KEAOSHA TERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1705 WASHINGTON ST, MONROE, LA 71201-7046
(318) 325-8050
Mailing address
1705 WASHINGTON ST, MONROE, LA 71201-7046
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
20150891
LA
Other
Enumeration date
05/23/2018
Last updated
05/23/2018
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