Individual
SUSAN PAGE OETZEL HUSBAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2906 N STATE ST, STE 301, JACKSON, MS 39216-4233
(601) 982-1001
(601) 982-1288
Mailing address
PO BOX 757, JACKSON, MS 39205-0757
(601) 982-1001
(601) 982-1288
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F0606227
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F0606227
CERTIFICATION
MS
Enumeration date
02/05/2007
Last updated
07/08/2007
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