Basic Information
| Provider Information | |||||||||
| NPI: | 1043773815 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALBRECHT | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | H | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9454 THREE RIVERS RD STE D | ||||||||
| Address2: | |||||||||
| City: | GULFPORT | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395034294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2285752660 | ||||||||
| FaxNumber: | 2288630502 | ||||||||
| Practice Location | |||||||||
| Address1: | 9454 THREE RIVERS RD STE D | ||||||||
| Address2: | |||||||||
| City: | GULFPORT | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395034294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2285752660 | ||||||||
| FaxNumber: | 2288630502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2019 | ||||||||
| LastUpdateDate: | 04/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 903155 | MS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.