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Individual

STEPHANIE BREAULT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
256 STATE HIGHWAY Y, FORSYTH, MO 65653-5618
(417) 546-4200
(417) 546-4505
Mailing address
PO BOX 1240, FORSYTH, MO 65653-1240
(417) 546-4200
(417) 546-4505

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2021011336
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2021011336
LICENSE NUMBER
MO
Enumeration date
04/05/2021
Last updated
04/05/2021
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