Manivanh A Prudhomme, MSN, FNP-BC, AGACNP-
NPI #1144831140 in Vicksburg, Mississippi
Provider Information
- NPI Number
- 1144831140
- Entity Type
- Individual
- Name
- Manivanh A Prudhomme, MSN, FNP-BC, AGACNP-
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Nurse Practitioner - Family
- Credential
- MSN, FNP-BC, AGACNP-
- Enumeration Date
- Aug 12, 2020
- Last Updated
- Jul 13, 2021
Practice Location
- Address
- 2011 HIGHWAY 61 N
- City
- Vicksburg
- State
- Mississippi
- ZIP Code
- 39183-3918
- Phone
- (014) 562-2776
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nurse Practitioner - Family — Family |
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