MEDICARE: MRS. VERA MITCHELL WARE RRT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2279H0200X	Home Health Registered Respiratory Therapist	LT3525	LA
2	2279P1005X	Pulmonary Rehabilitation Registered Respiratory Therapist	LT3525	LA

General Provider Information

NPI Number	:	1841501467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VERA MITCHELL WARE RRT

Provider Business Mailing Address
First Line	:	9591 WALLACE LAKE RD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-7535
Country	:	US
Telephone Number	:	318-687-8813
Fax Number	:	318-687-8813

Provider Business Practice Location Address
First Line	:	9591 WALLACE LAKE RD
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71106-7535
Country	:	US
Telephone Number	:	318-687-8813
Fax Number	:	318-687-8813

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2010
Last Update Date	:	06/29/2010

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