Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 20822 | TX |
NPI | 1083628093 |
---|---|
Provider Name | Dr. Emily Steger Neeley |
First Address | Shreveport, LA 71103-3822 |
Second Address | Shreveport, LA 71103-4228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 04/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
156569901 | (05) | TX |
156569903 | (05) | TN |
88D135 | BLUE CROSS BLUE SHIELD (01) | TX |