Individual
MRS. SHAWNTA SENICE GANDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
27 CANDELABRA ST, PETAL, MS 39465-9008
(601) 620-8011
Mailing address
27 CANDELABRA ST, PETAL, MS 39465-9008
(601) 620-8011
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R883735
MS
363LF0000X
Family Nurse Practitioner
Primary
R883735
MS
Other
Enumeration date
08/04/2014
Last updated
10/05/2015
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