Individual
MANIVANH A PRUDHOMME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, FNP-BC, AGACNP-
Contact information
Practice address
2011 HIGHWAY 61 N, VICKSBURG, MS 39183-3918
(014) 562-2776
(601) 456-2622
Mailing address
2011 HIGHWAY 61 N, VICKSBURG, MS 39183
(601) 456-2277
(601) 456-2622
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
904068
MS
Other
Enumeration date
08/12/2020
Last updated
07/13/2021
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