Individual
BRENDA DARNETTA SHUTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
330B HIGHWAY 90, GAUTIER, MS 39553-5744
(228) 497-0690
Mailing address
1505 RIVERSIDE DR, GAUTIER, MS 39553-2850
(228) 623-3319
Taxonomy
Speciality
Code
Description
License number
State
163WR0400X
Rehabilitation Registered Nurse
Primary
510505
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018214
—
MS
Enumeration date
07/07/2020
Last updated
07/07/2020
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