Individual
REVELYN GUTHRIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2165 KINGSFORD DR, FLORISSANT, MO 63031-2734
(314) 283-3394
Mailing address
2165 KINGSFORD DR, FLORISSANT, MO 63031-2734
(314) 283-3394
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
85-3277704
—
MO
Enumeration date
10/03/2020
Last updated
10/13/2020
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