Individual
JERID LAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1333 S SAM HOUSTON BLVD, HOUSTON, MO 65483-2046
(573) 529-9355
Mailing address
452 COUNTY ROAD 5110, SALEM, MO 65560-8289
(573) 529-9355
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2020012036
MO
163WE0003X
Emergency Registered Nurse
Primary
2020012036
MO
Other
Enumeration date
01/10/2022
Last updated
05/25/2023
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