Individual
DONNA MOBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1600 BROAD AVE, GULFPORT, MS 39501-3603
(228) 861-1132
Mailing address
1600 BROAD AVE, GULFPORT, MS 39501-3603
(228) 861-1132
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
318068
MS
Other
Enumeration date
09/11/2019
Last updated
09/11/2019
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