Individual
LASTEFFIA J TODD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
210 HOSPITAL CIR, CHOCTAW, MS 39350-6781
(601) 656-2211
Mailing address
210 HOSPITAL CIR, CHOCTAW, MS 39350-6781
(601) 656-2211
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R593656
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00114872
—
MS
05
—
04007266
—
MS
Enumeration date
10/23/2006
Last updated
10/17/2007
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