Individual
MS. QUEENEICE BOYETTE GANISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
205 S DELTA ST, GREENVILLE, MS 38703-4420
(662) 822-3150
Mailing address
2492 MOURNING DOVE ST, GREENVILLE, MS 38701-8121
(662) 822-3150
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
902219
MS
Other
Enumeration date
12/18/2018
Last updated
12/18/2018
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