Individual
MARIA MORRISON DOMINICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
3446 POPP'S FERRY ROAD, DIBERVILLE, MS 39540
(228) 392-4153
Mailing address
PO BOX 18679, HATTIESBURG, MS 39404-8679
(601) 705-1901
(601) 705-1952
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
901428
MS
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
906771
MS
Other
Enumeration date
05/28/2021
Last updated
08/01/2024
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