Individual
MS. SHANNON RENEE GULLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 221-8411
Mailing address
9319 BELDEN DR, SHREVEPORT, LA 71118-3538
(318) 671-7846
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
05628
LA
Other
Enumeration date
10/21/2008
Last updated
10/21/2008
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