Individual
AMANDA BROADWAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RNFA
Contact information
Practice address
1007 JEFFERSON ST, LAUREL, MS 39440-4350
(601) 649-7802
(601) 428-7841
Mailing address
PO BOX 247, LAUREL, MS 39441-0247
(601) 399-6167
(601) 399-6281
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
Primary
R866035
MS
Other
Enumeration date
08/28/2007
Last updated
07/24/2014
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