Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 2018012275 | MO |
N | 363LG0600X | Nurse Practitioner - Gerontology | 2018012275 | MO |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 2018012275 | MO |
NPI | 1003303124 |
---|---|
Provider Name | Ms. Lauren Ann Mistler |
First Address | Columbia, MO 65203-2582 |
Second Address | Columbia, MO 65203-2582 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2018 |
Last Update Date | 25/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003303124 | (05) | MO |