Provider Demographics
NPI:1932209715
Name:JUZANG, RHODA LYNN
Entity Type:Individual
Prefix:MS
First Name:RHODA
Middle Name:LYNN
Last Name:JUZANG
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:RHODA
Other - Middle Name:LYNN
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FAMILY NURSE PRACT
Mailing Address - Street 1:PO BOX 4594
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39535-4594
Mailing Address - Country:US
Mailing Address - Phone:228-273-4096
Mailing Address - Fax:228-594-1765
Practice Address - Street 1:180 DEBUYS RD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4402
Practice Address - Country:US
Practice Address - Phone:228-273-4096
Practice Address - Fax:228-594-1765
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR870754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08755026Medicaid
MS358702YUPLOtherMS MEDICARE
MS4864514OtherMAILHANDLERS
MS12671825OtherCAQH
MSP01861916OtherMEDICARE RR
MS5198833OtherAETNA