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1346334992
RUSSELL ALLAN SLACK
SHREVEPORT, LA
NPI
1346334992
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
367500000X Nurse Anesthetist, Certified Registered
(Licence: LA AP03803)
Enumeration Date
2006-10-03
Last Update Date
2015-11-09
Business Address
-- RUSSELL ALLAN SLACK CRNA
3217 MABEL ST
SHREVEPORT, LA 71103-4022
Phone number: 318-631-9121
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Mailing Address
-- RUSSELL ALLAN SLACK CRNA
3217 MABEL ST
SHREVEPORT, LA 71103-4022
Phone number: 318-631-9121
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