Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | MO |
NPI | 1104052034 |
---|---|
Provider Name | Dr. Daphane Angela Simora |
First Address | Herculaneum, MO 63048-0113 |
Second Address | Herculaneum, MO 63048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2009 |
Last Update Date | 05/06/2009 |