Individual
MATTIE WOODBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6365 I 55 N, JACKSON, MS 39213-9742
(601) 718-0021
Mailing address
6365 I 55 N, JACKSON, MS 39213-9742
(601) 718-0021
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
880499
MT
Other
Enumeration date
12/23/2020
Last updated
12/23/2020
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