Individual
SUSAN M. CARBAJAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2809 DENNY AVE, PASCAGOULA, MS 39581-5301
(228) 809-5419
(228) 809-5076
Mailing address
2101 HIGHWAY 90, GAUTIER, MS 39553-5340
(228) 497-7576
(228) 497-8869
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
904490
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00072750
—
MS
Enumeration date
03/05/2021
Last updated
05/02/2022
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