Individual
MRS. DORTHA MAE RIDEOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2649 PALMER DR, GULFPORT, MS 39507-2846
(228) 731-3257
Mailing address
529 E PASS RD APT U, GULFPORT, MS 39507-3271
(228) 547-7088
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
12/26/2017
Last updated
12/26/2017
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