Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 2015003191 | MO |
NPI | 1003208877 |
---|---|
Provider Name | Jeremey Laflamme |
First Address | Jefferson City, MO 65110-4240 |
Second Address | Jefferson City, MO 65109-6023 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2015 |
Last Update Date | 29/05/2015 |