Individual
REBECCA TUSTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1115 N FRONTAGE RD, VICKSBURG, MS 39180-5102
(601) 634-8790
Mailing address
1115 N FRONTAGE RD, VICKSBURG, MS 39180-5102
(601) 634-8790
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R543349
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0118982
—
MS
Enumeration date
07/11/2006
Last updated
07/08/2007
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