Individual
TERESA YOLANDA SHIVERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICENSES
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
42D2254381
SC
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
05/17/2022
Last updated
08/19/2024
Update your record
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