Individual
SUSAN L DUBOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
1238 HIGHWAY 42, SUMRALL, MS 39482-9519
(601) 758-3100
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 758-3100
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R872039
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03388585
—
MS
01
—
12214870
C A Q H PROVIDER NUMBER
MS
01
—
926646
AETNA
MS
Enumeration date
02/21/2011
Last updated
06/12/2023
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