Individual
NICOLE STEPHANIE DEISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4524 N OLIVE ST, KANSAS CITY, MO 64116-2012
(303) 519-9935
Mailing address
4524 N OLIVE ST, KANSAS CITY, MO 64116-2012
(303) 519-9935
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2019045915
MO
171400000X
Health & Wellness Coach
Primary
2019045915
MO
174H00000X
Health Educator
2019045915
MO
Other
Enumeration date
04/03/2021
Last updated
04/03/2021
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