Individual
SHEILA FOMENKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3600 S NATIONAL AVE, SPRINGFIELD, MO 65807-7311
(417) 322-6622
(417) 350-1935
Mailing address
3600 S NATIONAL AVE, SPRINGFIELD, MO 65807-7311
(417) 322-6622
(417) 350-1935
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
869928
TX
363L00000X
Nurse Practitioner
2021032055
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2021032055
MO
Other
Enumeration date
08/09/2018
Last updated
08/27/2021
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