Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP03208 | LA |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | R892886 | MS |
NPI | 1174941553 |
---|---|
Provider Name | Sandra Smith Trumbach |
First Address | Bay St Louis, MS 39520-1658 |
Second Address | Bay St Louis, MS 39520-1658 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2014 |
Last Update Date | 15/04/2014 |