Individual
DONNA L BAUCUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
234 MAGNOLIA DR, RALEIGH, MS 39153-6016
(601) 782-9797
(601) 782-9790
Mailing address
234 MAGNOLIA DR, RALEIGH, MS 39153-6016
(601) 782-9797
(601) 782-9790
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R544019
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04174306
—
MS
Enumeration date
09/27/2006
Last updated
12/03/2015
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