Individual
JEANETTE SHABAZZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3890 BIENVILLE BLVD, OCEAN SPRINGS, MS 39564-5803
(228) 872-6291
(228) 875-3385
Mailing address
3616 HOSPITAL ST, PASCAGOULA, MS 39581-4117
(228) 769-1035
(228) 769-2780
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R885984
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07576018
—
MS
Enumeration date
10/08/2014
Last updated
01/11/2016
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