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1063768331
AMANDA STAUBLE
JACKSON, MS
NPI
1063768331
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: MS 903113)
Enumeration Date
2012-07-24
Last Update Date
2019-08-22
Business Address
AMANDA STAUBLE APRN
1225 N STATE ST
JACKSON, MS 39202
Phone number: 601-201-7188
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Mailing Address
AMANDA STAUBLE APRN
104 WOODSTOCK DR
VICKSBURG, MS 39180-5747
Phone number: 601-201-7188
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