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Search › Louisiana › 101YM0800X

Deeandriez Wallace

NPI 1669113239 · on the registry since 2022 · sole proprietor

Practice

Address
3003 Knight St
Suite 115
Shreveport, LA 71105
Phone
(318) 614-7314
Organisation at this address
Asum Medical Supply, Inc.
St. Genevive Health Care Services, Inc.
Inferred from a shared address, not stated in the registry.
Clinicians at this address
23

Registry record

Primary taxonomy
101YM0800X
101YM0800X
Also registered as
171M00000X
Licence states on file
LA
From the registry's licence fields, which are often incomplete.
Sex
Female
Record last updated
2023-02-03

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Louisiana