Individual
STEPHANIE HANNEKEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
201 N GARTH AVE, COLUMBIA, MO 65203-4105
(573) 449-3953
Mailing address
201 N GARTH AVE, COLUMBIA, MO 65203-4105
(573) 449-3953
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
RN 091052
MO
Other
Enumeration date
05/21/2013
Last updated
05/22/2013
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