Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 944 | MS |
NPI | 1093806648 |
---|---|
Provider Name | Dr. Janine Demoruelle Fox |
First Address | Gulfport, MS 39507-2643 |
Second Address | Gulfport, MS 39507-2643 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 18/03/2010 |