Provider Demographics
NPI:1881249167
Name:ENTWISTLE, STEPHANIE MARSIGLIA
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARSIGLIA
Last Name:ENTWISTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:MARSIGLIA
Other - Last Name:ENTWISTLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:720 JENKINS RD
Mailing Address - Street 2:720 JENKINS RD
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107
Mailing Address - Country:US
Mailing Address - Phone:318-464-2544
Mailing Address - Fax:
Practice Address - Street 1:2210 LINE AVE STE 207
Practice Address - Street 2:2210 LINE AVE STE 207
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-7110
Practice Address - Country:US
Practice Address - Phone:318-617-5993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty