Individual
REBECCA TARATUTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
940 W MOUNT VERNON ST, STE 100, NIXA, MO 65714-9618
(417) 724-5300
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2015034095
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
RR MCR
MO
05
—
PENDING
—
MO
Enumeration date
09/25/2015
Last updated
11/04/2015
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