Individual
SHANICA D THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
213 HODGE ST, WEST MONROE, LA 71291-2721
(318) 733-2113
Mailing address
213 HODGE ST, WEST MONROE, LA 71291-2721
(318) 733-2113
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
009392062
LA
Other
Enumeration date
04/01/2019
Last updated
04/01/2019
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