Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | ||
N | 101YS0200X | School Counselor | 216241 | MS |
NPI | 1114537651 |
---|---|
Provider Name | Renee Gusta |
First Address | Biloxi, MS 39531-2277 |
Second Address | Biloxi, MS 39531-2277 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2020 |
Last Update Date | 29/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
861387167 | MOBILE PH[EBOTOMY (01) |