Individual
SUSAN L MAHANEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9945 GREENTREE LN, SHREVEPORT, LA 71118-5218
(318) 344-6761
Mailing address
9945 GREENTREE LN, SHREVEPORT, LA 71118-5218
(318) 344-6761
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
792677200
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
792677200
N/A
FL
Enumeration date
10/25/2019
Last updated
10/25/2019
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