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1912579301
GINA YI INTHAVONG
SHREVEPORT, LA
NPI
1912579301
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363L00000X Nurse Practitioner
(Licence: LA 221149)
Enumeration Date
2021-07-14
Last Update Date
2021-07-14
Business Address
GINA YI INTHAVONG Nurse Practitioner
1800 BUCKNER ST STE C120
SHREVEPORT, LA 71101-4453
Phone number: 318-227-8899
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Mailing Address
GINA YI INTHAVONG Nurse Practitioner
1800 BUCKNER ST STE C120
SHREVEPORT, LA 71101-4453
Phone number: 318-227-8899
Copy
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