Individual
TOMMIE DALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3834 KENTUCKY DERBY DR, FLORISSANT, MO 63034-3323
(314) 276-8596
Mailing address
3834 KENTUCKY DERBY DR, FLORISSANT, MO 63034-3323
(314) 276-8596
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
2007024069
MO
Other
Enumeration date
03/13/2018
Last updated
03/13/2018
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