Individual
GLENDA F PITTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 261-3606
(601) 579-5166
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 261-3606
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R104180
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00114030
—
MS
05
—
1419613
—
LA
01
—
640507572OC
AMERICAN ADMIN GROUP
MS
Enumeration date
07/27/2006
Last updated
08/10/2020
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