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Individual

LAURICA MARRIOTT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
220 N ELM ST., MOUNTAIN VIEW, MO 65548-8347
(417) 247-5543
Mailing address
PO BOX 32, MOUNTAIN VIEW, MO 65548-7109
(417) 256-9111

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2009021791
MO
363LF0000X
Family Nurse Practitioner
Primary
F0616628
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1811346158
MO
Enumeration date
06/07/2016
Last updated
05/30/2017
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