Individual
CLARISSA NORTHERN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
925 HIGHWAY VV, KENNETT, MO 63857-0071
(573) 359-2600
(573) 359-6200
Mailing address
925 HIGHWAY VV, KENNETT, MO 63857-0071
(573) 359-2600
(573) 359-6200
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2009029787
MO
Other
Enumeration date
01/22/2015
Last updated
01/22/2015
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