Healthcare Provider Details

I. General information

NPI: 1104847920
Provider Name (Legal Business Name): MARCELLA COLEMAN WILLIAMS N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY DEPARTMENT OF PEDIATRICS
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

1501 KINGS HWY DEPARTMENT OF PEDIATRICS
SHREVEPORT LA
71103-4228
US

V. Phone/Fax

Practice location:
  • Phone: 318-675-6076
  • Fax: 318-675-6059
Mailing address:
  • Phone: 318-675-6076
  • Fax: 318-675-6059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberRN057969
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: