Individual
PORTUGAL O'BRAINT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MLS(ASCP)
Contact information
Practice address
83 MANNING ROAD, MERIGOLD, MS 38759
(662) 410-9196
Mailing address
PO BOX 70, MERIGOLD, MS 38759-0070
(662) 410-9196
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
266584
IL
Other
Enumeration date
07/09/2024
Last updated
07/09/2024
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