Individual
TYQUANNA BURNS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6899 PATRICK LN STE B3, SHREVEPORT, LA 71129-9476
(318) 464-4501
Mailing address
6899 PATRICK LN STE B3, SHREVEPORT, LA 71129-9476
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
319440
TX
Other
Enumeration date
07/03/2018
Last updated
07/03/2018
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