Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | R866022 | MS |
NPI | 1033571054 |
---|---|
Provider Name | Debra Gail Gill |
First Address | Southaven, MS 38672-9571 |
Second Address | Southaven, MS 38672-9571 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2016 |
Last Update Date | 29/03/2016 |