Provider Demographics
NPI:1992456453
Name:ESSENCE NURSE LLC
Entity type:Organization
Organization Name:ESSENCE NURSE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:601-934-9629
Mailing Address - Street 1:590 HIGHWAY 18 W
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39355-8739
Mailing Address - Country:US
Mailing Address - Phone:601-934-9629
Mailing Address - Fax:
Practice Address - Street 1:590 HIGHWAY 18 W
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:MS
Practice Address - Zip Code:39355-8739
Practice Address - Country:US
Practice Address - Phone:601-934-9629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-15
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory