Individual
MRS. SANDRA ELIZABETH EUBANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
1699 SOUTH COLORADO ST, GREENVILLE, MS 38703
(662) 390-8992
(662) 335-7933
Mailing address
1699 SOUTH COLORADO ST, GREENVILLE, MS 38703
(662) 390-8992
(662) 335-7933
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
R782766
MS
363LF0000X
Family Nurse Practitioner
Primary
R782766
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0117720
—
MS
01
—
132855758
AR MEDICAID
MS
01
—
500004826
RR MEDICARE
MS
Enumeration date
06/23/2006
Last updated
09/13/2012
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