Individual
DEANA MARIE SELF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
2820 E ROCK HAVEN RD, SUITE 100, HARRISONVILLE, MO 64701-4411
(816) 380-3582
(816) 380-6964
Mailing address
25310 S STATE ROUTE K, HARRISONVILLE, MO 64701-9179
(606) 200-6638
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2010038269
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578863841
—
MO
Enumeration date
11/02/2010
Last updated
06/02/2022
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