Individual
MRS. MIRANDA RENEE WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
5646 READ BLVD # 280, NEW ORLEANS, LA 70127-3106
(504) 246-1452
Mailing address
PO BOX 672, HAMMOND, LA 70404-0672
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP09831
LA
Other
Enumeration date
08/20/2018
Last updated
08/20/2018
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