Individual
MR. JACQUELINE SUE PERDUE-DORATHY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
550 POPE AVE, FORT LEAVENWORTH, KS 66027-2332
(913) 681-6170
Mailing address
19445 COUNTRYSIDE CIR, WESTON, MO 64098-9127
(913) 684-6170
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
23-27018-081
KS
Other
Enumeration date
04/26/2007
Last updated
07/08/2007
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