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JEFFREY THOMAS SHADRACH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
AGNP

Contact information

Practice address
13655 RIVERPORT DR, MARYLAND HEIGHTS, MO 63043-4812
(314) 592-7000
Mailing address
4918 SILO HILLS DR, SPRINGFIELD, MO 65802-7121
(417) 844-2669

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2021044288
MO
363LG0600X
Gerontology Nurse Practitioner
2021044288
MO

Other

Enumeration date
06/24/2022
Last updated
06/24/2022
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