Individual
MANDISA FAYOLA MCCORMICK- NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ASSISTIVE CARE PRO
Contact information
Practice address
1534 BEECHER DR, SAINT LOUIS, MO 63136-2306
(131) 422-9122
Mailing address
1534 BEECHER DR, SAINT LOUIS, MO 63136-2306
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
MO
3747A0650X
Attendant Care Provider
—
—
Other
Enumeration date
11/24/2020
Last updated
01/19/2021
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