Healthcare Provider Details

I. General information

NPI: 1710233721
Provider Name (Legal Business Name): ELVIRA CEHAJIC APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LINE AVE STE 100
SHREVEPORT LA
71101-4639
US

IV. Provider business mailing address

1534 ELIZABETH AVE STE 301
SHREVEPORT LA
71101-4531
US

V. Phone/Fax

Practice location:
  • Phone: 318-635-3052
  • Fax: 318-635-3072
Mailing address:
  • Phone: 318-629-5001
  • Fax: 318-629-5020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP07006
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: