Individual
LARRY BOURRAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
12485 SCHAMBERVILLE LN, COLLINSVILLE, MS 39325-9195
(601) 480-4754
Mailing address
12485 SCHAMBERVILLE LN, COLLINSVILLE, MS 39325-9195
(601) 480-4754
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
R890304
MS
Other
Enumeration date
01/17/2024
Last updated
01/17/2024
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