Provider Demographics
NPI:1407885189
Name:PEARSON, LUANN KARSTEN (LOTR)
Entity Type:Individual
Prefix:MRS
First Name:LUANN
Middle Name:KARSTEN
Last Name:PEARSON
Suffix:
Gender:F
Credentials:LOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9518 HAMPSTEAD CIR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7698
Mailing Address - Country:US
Mailing Address - Phone:318-272-0095
Mailing Address - Fax:318-798-0607
Practice Address - Street 1:9518 HAMPSTEAD CIR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7698
Practice Address - Country:US
Practice Address - Phone:318-272-0095
Practice Address - Fax:318-798-0607
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ10240174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAZ10240OtherLICENSE NUMBER
LA1310077Medicare ID - Type Unspecified