Individual
TAMBRA TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3814 CRESTVIEW WAY, SHREVEPORT, LA 71119-6531
(318) 465-0119
Mailing address
3814 CRESTVIEW WAY, SHREVEPORT, LA 71119-6531
(318) 465-0119
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
01/04/2021
Last updated
01/04/2021
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