Individual
DIANE VAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DNP, FNP
Contact information
Practice address
205 MARION AVE, MCCOMB, MS 39648-2705
(601) 684-9116
(601) 684-9126
Mailing address
334 25TH ST, MCCOMB, MS 39648-5510
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
902568
MS
363LF0000X
Family Nurse Practitioner
Primary
904388
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/25/2020
Last updated
11/04/2021
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