Healthcare Provider Details

I. General information

NPI: 1891941589
Provider Name (Legal Business Name): MICHELLE WINSLOW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E STONER AVE
SHREVEPORT LA
71101-4243
US

IV. Provider business mailing address

510 E STONER AVE
SHREVEPORT LA
71101-4243
US

V. Phone/Fax

Practice location:
  • Phone: 318-221-8411
  • Fax:
Mailing address:
  • Phone: 318-221-8411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number88774
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number88774
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: