Individual
DR. JOHNNIE SUSAN COOPER WIJEWARDANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD, FNP
Contact information
Practice address
1430 CEDAR CREEK LN, STARKVILLE, MS 39759-8488
(662) 312-1021
Mailing address
1430 CEDAR CREEK LN, STARKVILLE, MS 39759-8488
(662) 312-1021
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R852708
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04887214
—
MS
Enumeration date
09/09/2008
Last updated
03/15/2012
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