Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 1999137572 | MO |
NPI | 1003228909 |
---|---|
Provider Name | Melinda Dawn Dugal |
First Address | Kansas City, MO 64180-1143 |
Second Address | Farmington, MO 63640-1919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2014 |
Last Update Date | 04/03/2021 |