Individual
MISS VANDRIKA DELANIA MANUEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8786 N CREEK BLVD APT 6-11, SOUTHAVEN, MS 38671-7218
(901) 820-6782
Mailing address
8786 N CREEK BLVD APT 6-11, SOUTHAVEN, MS 38671-7218
(901) 820-6782
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
07/12/2022
Last updated
07/12/2022
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