Individual
MISS DOMINIQUE STEVENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6800 RASBERRY LANE APT.1901, SHREVEPORT, LA 71129
(318) 834-5287
Mailing address
6800 RASBERRY LN APT 1901, SHREVEPORT, LA 71129-2525
(318) 834-5287
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
174400000X
Specialist
—
—
Other
Enumeration date
04/21/2017
Last updated
03/06/2019
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