Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 213785 | LA |
N | 363LG0600X | Nurse Practitioner - Gerontology | 213785 | LA |
NPI | 1003427899 |
---|---|
Provider Name | Mrs. Collette G Brown |
First Address | Shreveport, LA 71108-5911 |
Second Address | Bossier City, LA 71111-1914 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2020 |
Last Update Date | 14/08/2020 |