Individual
MR. GABRIEL LEWIS MACIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, NNP-BC
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-4775
Mailing address
817 TERRAPIN LN, BRANDON, MS 39047-8338
(318) 332-9085
Taxonomy
Speciality
Code
Description
License number
State
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
R901038
MS
Other
Enumeration date
08/13/2015
Last updated
10/22/2015
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