Organization
GAUTIER FAMILY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA R. BOLEWARE FNP (OWNER)
(601) 800-8580
Entity
Organization
Contact information
Practice address
4533B GAUTIER VANCLEAVE RD, GAUTIER, MS 39553
(228) 202-5924
(228) 202-5918
Mailing address
MARCIA EASTERWOOD, P.O. BOX 177, ELLISVILLE, MS 39437
(601) 800-8580
(601) 800-8583
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/08/2021
Last updated
10/08/2021
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