Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | MO |
NPI | 1073045340 |
---|---|
Provider Name | Iesha Joseph |
First Address | Saint Louis, MO 63130-2322 |
Second Address | Saint Louis, MO 63130-2322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2017 |
Last Update Date | 28/03/2017 |