Individual
NICKOLAOS THOMAS PORTARITIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.N.
Contact information
Practice address
5001 HARDY ST, HATTIESBURG, MS 39402-1308
(601) 268-8000
Mailing address
PO BOX 17826, HATTIESBURG, MS 39404-7826
(601) 447-8207
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
R873027
MS
Other
Enumeration date
04/25/2012
Last updated
04/25/2012
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