Most Relevant Information
Provider Data
| NPI Number: | 1003664814 |
| Provider Name: | MARISA JEFFERSON |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/07/2024 |
| Last Updated: | 05/07/2024 |
Provider Practice Location
3018 OLD MINDEN RD STE 1117
BOSSIER CITY
LA
711122497
Practice Location Phone/Fax
| Phone: | 3187461935 |
| Fax: |
Provider Mailing Location
3018 OLD MINDEN RD STE 1117
BOSSIER CITY
LA
711122497
Provider Mailing Phone/Fax
| Phone: | 3187461935 |
| Fax: |