Individual
JENNIFER MOUTRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3801 S NATIONAL AVE, SPRINGFIELD, MO 65807-5210
(417) 269-4557
Mailing address
1000 E PRIMROSE ST STE 520, SPRINGFIELD, MO 65807-5180
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2006021598
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2006021598
LICENSE
MO
Enumeration date
07/19/2016
Last updated
07/19/2016
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