Individual
NICOLE DAVOLT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PROVIDER
Contact information
Practice address
112 N JOHNSON ST., KAHOKA, MO 63445
(319) 931-4237
Mailing address
112 N JOHNSON ST., KAHOKA, MO 63445
(319) 931-4237
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
03/22/2017
Last updated
03/22/2017
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