Provider Demographics
NPI:1831842541
Name:LANDTROOP, DONNELL JULIETTE
Entity type:Individual
Prefix:
First Name:DONNELL
Middle Name:JULIETTE
Last Name:LANDTROOP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 HIGHWAY 90 APT 115
Mailing Address - Street 2:
Mailing Address - City:WAVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39576-2476
Mailing Address - Country:US
Mailing Address - Phone:228-671-0700
Mailing Address - Fax:
Practice Address - Street 1:616 HIGHWAY 90 APT 115
Practice Address - Street 2:
Practice Address - City:WAVELAND
Practice Address - State:MS
Practice Address - Zip Code:39576-2476
Practice Address - Country:US
Practice Address - Phone:228-671-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider