Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0216X | Pediatric Rheumatologist | MT209380 | PA |
NPI | 1619236106 |
---|---|
Provider Name | Laura Ashley Tasan |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2012 |
Last Update Date | 22/08/2019 |