Individual
MRS. BETTY MACIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1220 JEFFERSON ST, LAUREL, MS 39440-4355
(601) 426-4507
(601) 426-4228
Mailing address
PO BOX 607, LAUREL, MS 39441-0607
(601) 426-4507
(401) 426-4228
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R831042
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00114015
—
MS
Enumeration date
05/27/2006
Last updated
12/26/2007
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