Individual
LATONYA THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3444 WISCONSIN AVE, VICKSBURG, MS 39180-5331
(601) 638-0031
Mailing address
3444 WISCONSIN AVE, VICKSBURG, MS 39180-5331
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
327059
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018215
—
MS
Enumeration date
10/10/2017
Last updated
10/10/2017
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