Healthcare Provider Details

I. General information

NPI: 1912289919
Provider Name (Legal Business Name): VERONICA MONIQUE MARSHALL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 E 70TH ST
SHREVEPORT LA
71105-5321
US

IV. Provider business mailing address

2205 E 70TH ST
SHREVEPORT LA
71105-5321
US

V. Phone/Fax

Practice location:
  • Phone: 318-797-1585
  • Fax: 318-797-6077
Mailing address:
  • Phone: 318-797-1585
  • Fax: 318-797-6077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP06629
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: