Individual
MRS. KELLY MARIE PANTAZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
3647 KNEFF FARM XING, IMPERIAL, MO 63052-2887
(314) 882-1978
Mailing address
3647 KNEFF FARM XING, IMPERIAL, MO 63052-2887
(314) 882-1978
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2018024080
MO
Other
Enumeration date
08/15/2018
Last updated
08/15/2018
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