Individual
LAURA MIRIAM NUSSDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1000
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
T-5238
MS
390200000X
Student in an Organized Health Care Education/Training Program
T-5238
MS
Other
Enumeration date
03/26/2024
Last updated
07/15/2024
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