Doctor Name: | DENISE DAIGLE |
NPI Number: | 1609149392 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | R858700 |
Business Practice Address: | 149 Drinkwater Rd Bay St Louis, MS - 395201658 |
Business Phone Number: | 2284678600 |
Business Fax Number: | 2284678797 |
Mailing Address: | 11520 Pine Dr, GULFPORT |
State: | MS |
Postal Code: | 395033911 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 02/11/2012 |
NPI Last Update Date: | 02/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R858700 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |