Individual
MRS. JO ELLEN FUENTES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
15238 BROADMOOR ST, OVERLAND PARK, KS 66223-3137
(816) 529-7307
Mailing address
8610 STARK AVE, RAYTOWN, MO 64138-3165
(816) 529-7307
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
THR-587
KS
Other
Enumeration date
03/25/2007
Last updated
07/08/2007
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