Individual
MIRIAM MARIE SHOEMAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 PEACHTREE ST, JACKSON, MS 39202-1754
(601) 951-6896
Mailing address
1034 HIGHWAY 3048, RAYVILLE, LA 71269-4044
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
ATHLETIC TRAINER
—
Enumeration date
04/19/2018
Last updated
04/19/2018
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