Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 20965 | MS |
NPI | 1104002898 |
---|---|
Provider Name | Dr. Vanessa Lackey Sandifer |
First Address | Jackson, MS 39216-0450 |
Second Address | Jackson, MS 39216-4643 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2008 |
Last Update Date | 11/08/2010 |