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General NPI Number Information
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NPI Number | 1265725402
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Entity Type | Individual
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Provider Name | KATHERINE MARANTO SALLEY APRN, WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/20/2011
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Last Update Date | 05/20/2011
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Provider Practice Location Address
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Address Line | 827 MARGARET PL SUITE 201
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City | SHREVEPORT
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State | LA
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Zip | 71101-4523
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Country | US
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Telephone | 318-227-2912
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Fax |
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Provider Business Mailing Address
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Address Line | 4462 RED BLUFF RD
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City | GLOSTER
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State | LA
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Zip | 71030-3285
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Country | US
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Telephone | 318-461-2560
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | RN113773-AP06407
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License Number State | LA
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