Individual
MRS. ELIZABETH BROOKE WILBANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2000 E SHILOH RD, CORINTH, MS 38834-3724
(662) 287-6999
Mailing address
868 COUNTY ROAD 518, RIENZI, MS 38865-9001
(662) 603-1117
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R874715
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03200304
—
MS
Enumeration date
08/13/2012
Last updated
11/18/2013
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