Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 117554 | MO |
NPI | 1043275100 |
---|---|
Provider Name | Mrs. Dianne S Castle |
First Address | Saint Joseph, MO 64506-2459 |
Second Address | Saint Joseph, MO 64506-2459 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q62590 | (02) |