Individual
MISS LURETTA L MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSHAE
Contact information
Practice address
9013 TANK RD, CRYSTAL SPRINGS, MS 39059-9628
(601) 503-4657
Mailing address
9013 TANK RD, CRYSTAL SPRINGS, MS 39059-9628
(601) 503-4657
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
296056
MS
Other
Enumeration date
04/14/2022
Last updated
04/14/2022
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