Individual
STEPHANIE M DAMITIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.R.N.A
Contact information
Practice address
15190 COMMUNITY RD STE 230A, GULFPORT, MS 39503-3483
(228) 831-0204
(228) 831-1868
Mailing address
15190 COMMUNITY RD STE 230A, GULFPORT, MS 39503-3483
(228) 831-0204
(228) 831-1868
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R876698
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R877698
LICENSE NUMBER
MS
Enumeration date
10/08/2009
Last updated
11/04/2009
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