Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP06760 | LA |
NPI | 1033482492 |
---|---|
Provider Name | Mrs. Stephanie Ann Presley |
First Address | Shreveport, LA 71101-4443 |
Second Address | Shreveport, LA 71101-4443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2012 |
Last Update Date | 30/08/2012 |