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Individual

JAN LUCILE ALTISER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PMHNP-BC

Contact information

Practice address
1601 E 28TH ST, TRENTON, MO 64683-1178
(660) 359-4487
(660) 359-4129
Mailing address
PO BOX 30, TRENTON, MO 64683-0030
(660) 359-4487
(660) 359-4129

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2010013176
MO
363LF0000X
Family Nurse Practitioner
2010013176
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2010013176
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
424240901
MO
Enumeration date
12/16/2009
Last updated
02/03/2023
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