Individual
STEPHANIE POLISTICO COOPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
203 N GRAND ST, SALEM, MO 65560-1344
(573) 729-4103
Mailing address
5 N WATER ST, SALEM, MO 65560-1425
(573) 453-0516
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2021049377
MO
Other
Enumeration date
03/30/2022
Last updated
03/30/2022
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