Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | RN184038 | GA |
NPI | 1134630858 |
---|---|
Provider Name | Mrs. Marjorie Yvette Elibert |
First Address | Tyrone, GA 30290-2178 |
Second Address | Tyrone, GA 30290 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2017 |
Last Update Date | 10/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1134630858 | (05) | GA |