Individual
JOSETTA ELIESE WAHWASSUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, FNP, PMHNP
Contact information
Practice address
206 S MILL ST, ELDON, MO 65026-1864
(888) 403-1071
Mailing address
1800 COMMUNITY, CLINTON, MO 64735-8804
(660) 885-8131
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
096721
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
096721
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
44870
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29929044
BLUE CROSS BLUE SHIELD
—
05
—
423989722
—
MO
01
—
P00430963
RAILROAD MEDICARE
—
Enumeration date
01/27/2006
Last updated
06/28/2021
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