Healthcare Provider Details

I. General information

NPI: 1699380527
Provider Name (Legal Business Name): GLORIA PRELOW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 KNIGHT ST STE 426
SHREVEPORT LA
71105-2414
US

IV. Provider business mailing address

6644 N LAKESHORE DR
SHREVEPORT LA
71107-9486
US

V. Phone/Fax

Practice location:
  • Phone: 318-754-3560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: