Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1896 | AL |
Y | 103T00000X | Psychologist | 1896 | AL |
NPI | 1003228719 |
---|---|
Provider Name | Dr. Elizabeth Nosen |
First Address | Jackson, MS 39216-5116 |
Second Address | Jackson, MS 39216-5116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2014 |
Last Update Date | 29/05/2014 |