NPI 1104337856

Constance Colettle Ellis

Practitioner Community Health Worker Shreveport, LA

Practice location

Address: 9245 Wallace Lake Rd STE a, Shreveport, LA 71106
Phone: (318) 221-2828
Mailing address: PO Box 349, Stonewall, LA 71078-0349

Registered specialties (2)

Community Health Worker Primary

Other Service Providers Taxonomy 172V00000X

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Case Manager/Care Coordinator

Other Service Providers Taxonomy 171M00000X

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Registry record

NPI: 1104337856
Entity type: Individual
Sex (as registered): Female
NPI issued: 21 Oct 2017
Record last updated: 17 May 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.