Individual
TESS MARYANNE MAUBACH IX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
118 COLLEGE DR, HATTIESBURG, MS 39406-0002
(601) 266-1000
Mailing address
118 COLLEGE DR, HATTIESBURG, MS 39406-0002
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
MS
2255A2300X
Athletic Trainer
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TEA806249754
BLUE CROSS & BLUE SHEILD
IL
Enumeration date
09/21/2022
Last updated
11/29/2022
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