Individual
MISS JULIETTE SHIVERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NUTRION PROFESSIONAL
Contact information
Practice address
219 E GREGG ST, SHREVEPORT, LA 71104-5158
(318) 572-6157
(800) 708-7349
Mailing address
219 E GREGG ST, SHREVEPORT, LA 71104-5158
(318) 572-6157
(800) 708-7349
Taxonomy
Speciality
Code
Description
License number
State
133NN1002X
Nutrition Education Nutritionist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00696F
MEDICARE PART B PROVIDER
TX
01
—
0P21130
MEDICARE PART B PROVIDER
MI
Enumeration date
06/12/2006
Last updated
03/18/2024
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