Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | R850781 | MS |
NPI | 1013283829 |
---|---|
Provider Name | Ms. Vanessa Norman |
First Address | Meridian, MS 39305 |
Second Address | Newton, MS 39345 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2012 |
Last Update Date | 20/08/2018 |