Healthcare Provider Details

I. General information

NPI: 1639594930
Provider Name (Legal Business Name): US STAR NURSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2014
Last Update Date: 02/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 PRIMROSE LN
NATCHEZ MS
39120-4877
US

IV. Provider business mailing address

7 PRIMROSE LN 48 EAST WOODLAWN STREET
NATCHEZ MS
39120-4877
US

V. Phone/Fax

Practice location:
  • Phone: 601-304-2043
  • Fax:
Mailing address:
  • Phone: 601-304-2043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR863813
License Number StateMS

VIII. Authorized Official

Name: MS. TARSHA CARTER AMBEAU
Title or Position: FAMILY NURSE PRACTITIONER
Credential:
Phone: 601-304-2043