Organization
COUNTRY CARE FAMILY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA VICTORIA NANCE NP-C (NURSE PRACTITIONER/ OFFICE MANAGER)
(573) 429-6698
Entity
Organization
Contact information
Practice address
3 E CLEVELAND AVE, ELLSINORE, MO 63937
(573) 429-6698
Mailing address
PO BOX 446, ELLSINORE, MO 63937-0446
(573) 429-6698
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Enumeration date
10/31/2018
Last updated
10/31/2018
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