Facts
- Status
- A
- Credential
- FNP-C, RN
- Type
- Individual
- Enumeration date
- 2017-05-01
- Last updated
- 2018-05-16
Specialties
Licenses
- License MO
- 2017009934
Location
- Practice location
- 1326 S SERVICE RD W STE 10
- City
- SULLIVAN MO
- Postal code
- 63080
- Phone
- 573-468-4455
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.