Individual
JENNIFER RACHELLE VANDELOECHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1306 W MAIN ST, JEFFERSON CITY, MO 65109-1356
(573) 644-6344
(573) 644-6342
Mailing address
1306 W MAIN ST, JEFFERSON CITY, MO 65109-1356
(573) 644-6344
(573) 644-6342
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2008004535
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356556625
NATIONAL PROVIDER NUMBER
MO
Enumeration date
06/28/2021
Last updated
06/28/2021
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