Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | R710121 | MS |
NPI | 1013105691 |
---|---|
Provider Name | Seng P Pang |
First Address | Clarksdale, MS 38614-8524 |
Second Address | Marks, MS 38646-9785 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2007 |
Last Update Date | 13/02/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09207801 | (05) | MS |