Individual
MRS. NANCY JEANNE KLOS
Active
Individual
MRS. NANCY JEANNE KLOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
036916
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036916
DIVISION OF PROFESSIONAL REGISTRATION COSMETOLOGIST
MO
01
—
16945832
SALES TAX ID
MO
Enumeration date
06/02/2010
Last updated
06/02/2010
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