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Individual

MRS. LISA J SMITH

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN,MSN,NP

Contact information

Practice address
17300 N. OUTER 40, STE 100, CHESTERFIELD, MO 63005
(636) 519-8889
Mailing address
18926 WILDHORSE CREEK, WILDWOOD, MO 63005
(636) 519-4084

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
R3N29
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
104229
RN LICENSE NUMBER
MO
Enumeration date
05/03/2007
Last updated
07/08/2007
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