Individual
GWEN M MAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
819 S BUS HWY 13, LEXINGTON, MO 64067-1515
(660) 259-3898
Mailing address
14223 HIGHWAY U, ODESSA, MO 64076-6467
(608) 343-8808
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
16W00000X
MO
Other
Enumeration date
08/15/2014
Last updated
08/15/2014
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