Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 2021029249 | MO |
NPI | 1023789765 |
---|---|
Provider Name | Katie Schweder |
First Address | Savannah, MO 64485-2482 |
Second Address | Savannah, MO 64485-2482 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2021 |
Last Update Date | 22/09/2021 |