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Individual

DELORES A. VANDERGRIFT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
2425 FAIRLAWN DR, CARTHAGE, MO 64836-3517
(417) 237-0604
(417) 237-0613
Mailing address
2425 FAIRLAWN DR, CARTHAGE, MO 64836-3517
(417) 237-0604
(417) 237-0613

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
079678
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1790723260
MO
Enumeration date
06/04/2006
Last updated
11/19/2014
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