Individual
MS. GERICA MICHELLE TILLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
151 FREESTATE BLVD, SHREVEPORT, LA 71107-6535
(318) 226-5990
(318) 675-0543
Mailing address
220 DECATUR ST, BOSSIER CITY, LA 71111-6258
(318) 347-6653
(318) 675-0543
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
206282
LA
164W00000X
Licensed Practical Nurse
20180753
LA
Other
Enumeration date
05/17/2021
Last updated
09/12/2022
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