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Individual

MRS. LILLIAN LORRAINE DUBARD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CFNP

Contact information

Practice address
965 AVENT DR, SUITE 107, GRENADA, MS 38901-5045
(662) 227-7575
(662) 227-6575
Mailing address
965 AVENT DR, SUITE 107, GRENADA, MS 38901-5045
(662) 227-7575
(662) 227-6575

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R713066
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
02654890
MS
Enumeration date
07/21/2006
Last updated
03/30/2012
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