Individual
MR. JEREMY GLENN COFFELT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
126 MISSOURI AVE, FORT LEONARD WOOD, MO 65473-8952
(573) 596-1600
(573) 596-0555
Mailing address
1607 HISTORIC 66 W LOT 6, WAYNESVILLE, MO 65583-2465
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2006031395
MO
Other
Enumeration date
08/25/2010
Last updated
08/25/2010
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