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1407833221
WANDERFUL PORTER
TUPELO, MS
NPI
1407833221
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Former Name
WANDA E FORD
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
207Q00000X Family Medicine
(Licence: MS R748355)
Enumeration Date
2005-12-22
Last Update Date
2016-06-09
Business Address
-- WANDERFUL PORTER FNP-BC
602 BRUNSON DR
TUPELO, MS 38801-4947
Phone number: 662-680-3855
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Mailing Address
-- WANDERFUL PORTER FNP-BC
602 BRUNSON DR
TUPELO, MS 38801-4947
Phone number: 662-680-3855
Copy
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