Individual
MRS. AMANDA LAURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
4500 13TH ST, GULFPORT, MS 39501-2515
(228) 867-4000
Mailing address
4500 13TH ST, GULFPORT, MS 39501-2515
(228) 867-4000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R880057
MS
Other
Enumeration date
08/17/2014
Last updated
01/26/2015
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