Individual
GINA YI INTHAVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1800 BUCKNER ST STE C120, SHREVEPORT, LA 71101-4453
(318) 227-8899
(318) 425-3793
Mailing address
1800 BUCKNER ST STE C120, SHREVEPORT, LA 71101-4453
(318) 227-8899
(318) 425-3793
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
221149
LA
Other
Enumeration date
07/14/2021
Last updated
07/14/2021
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