Individual
TERESA DIANE WILSON GILLYARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
257 E GREGG ST, SHREVEPORT, LA 71104-5158
(318) 272-7706
Mailing address
257 E GREGG ST, SHREVEPORT, LA 71104-5158
(318) 272-7706
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN151774
LA
Other
Enumeration date
10/11/2024
Last updated
10/11/2024
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