Individual
JESSE VANDERSLUIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
155 RITA WAY, ELIZABETHTOWN, KY 42701-8344
(605) 261-7964
Mailing address
155 RITA WAY, ELIZABETHTOWN, KY 42701-8344
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
1141689
KY
Other
Enumeration date
03/22/2017
Last updated
03/22/2017
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