Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 2010039088 | MO |
NPI | 1043517253 |
---|---|
Provider Name | Karen Marie Rottler |
First Address | Manchester, MO 63088-1215 |
Second Address | Manchester, MO 63088-1215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2011 |
Last Update Date | 24/02/2011 |