Individual
ONELLIS STANFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1340 BROAD AVE, SUITE 310, GULFPORT, MS 39501-2404
(228) 575-1400
(228) 575-1414
Mailing address
PO BOX 1810, GULFPORT, MS 39502-1810
(228) 864-8454
(228) 865-1457
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R869199
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03335347
—
MS
Enumeration date
07/06/2009
Last updated
07/11/2014
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