RUSSELL ALLAN SLACK

SHREVEPORT, LA
NPI1346334992
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy367500000X Nurse Anesthetist, Certified Registered
(Licence: LA  AP03803)
Enumeration Date2006-10-03
Last Update Date2015-11-09
Business Address
-- RUSSELL ALLAN SLACK CRNA
3217 MABEL ST
SHREVEPORT, LA 71103-4022
Phone number: 318-631-9121
Mailing Address
-- RUSSELL ALLAN SLACK CRNA
3217 MABEL ST
SHREVEPORT, LA 71103-4022
Phone number: 318-631-9121
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