Individual
BONITA T ROBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1762 EDDISVILLE RD, DURANT, MS 39063-2910
(601) 955-8188
Mailing address
1762 EDDISVILLE RD, DURANT, MS 39063-2910
(601) 955-8188
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
P329470
MS
Other
Enumeration date
06/05/2020
Last updated
06/06/2020
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