Individual
SHEMIKA SQUARE TOLLIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10566 BIRCHWOOD DR, BATON ROUGE, LA 70807-2928
(225) 207-2580
Mailing address
10566 BIRCHWOOD DR, BATON ROUGE, LA 70807-2928
(225) 207-2580
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
7069492
LA
Other
Enumeration date
09/21/2021
Last updated
09/21/2021
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