Healthcare Provider Details

I. General information

NPI: 1982863619
Provider Name (Legal Business Name): LAURA OURSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA PERKINS MT(ASCP)

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 E WASHINGTON ST
SHREVEPORT LA
71104-3544
US

IV. Provider business mailing address

218 E WASHINGTON ST
SHREVEPORT LA
71104-3544
US

V. Phone/Fax

Practice location:
  • Phone: 318-402-5443
  • Fax:
Mailing address:
  • Phone: 318-402-5443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License NumberG4308
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: