Individual
MRS. JORDAN CAMILLE KIVRAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, MSN
Contact information
Practice address
216 STONE VIEW CT, FENTON, MO 63026-5108
(573) 300-1399
(573) 300-1399
Mailing address
216 STONE VIEW CT, FENTON, MO 63026-5108
(573) 300-1399
Taxonomy
Speciality
Code
Description
License number
State
163WN1003X
Nutrition Support Registered Nurse
Primary
2014019831
MO
Other
Enumeration date
05/10/2025
Last updated
05/20/2025
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