Individual
MISS FREDERICKA LYNETTE FAIRMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
504 EASTGATE DR, BROOKHAVEN, MS 39601-3106
(601) 748-1731
Mailing address
504 EASTGATE DR, BROOKHAVEN, MS 39601-3106
(601) 748-1731
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
083949
MS
Other
Enumeration date
12/10/2024
Last updated
01/01/2025
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