Individual
DESTEMONA BOZHANI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
105 FAR WEST DR STE 201, SAINT JOSEPH, MO 64506-3514
(816) 271-8182
Mailing address
5804 SW BRAY RD, CLARKSDALE, MO 64430-9176
(816) 262-2889
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
140231
KS
363L00000X
Nurse Practitioner
Primary
2020031429
MO
363LP2300X
Primary Care Nurse Practitioner
2020031429
MO
Other
Enumeration date
10/07/2020
Last updated
08/30/2021
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