Roan, Leisa Joan
Roan, Leisa Joan is an individual health care provider with primary practice located at 2539 Viking Dr Ste 100 , Bossier City LA 71111-1611. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Roan, Leisa Joan can be contacted via phone (318) 747-8105.Contact Information
Primary practice address
2539 Viking Dr Ste 100
Bossier City LA 71111-1611
Phone: (318) 747-8105
Fax: (318) 747-8150
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 214754 | Louisiana |
Profile Details
| NPI number | 1568078392 |
|---|---|
| LBN Legal business name | Roan, Leisa Joan |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 17th, 2020 |
| Last updated | Apr 8th, 2021 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1568078392 | NPPES |
| Louisiana | MEDICAID | 1023205 |
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