| NPI | 1285061788 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEGGY LORRAINE NOONAN Physician Business Services Dir. 228-575-1740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2013-09-30 |
| Last Update Date | 2024-01-09 |