Individual
MS. VETRES OREATHER STATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
650 JOEL DR, YOUNG EAGLE CLINIC, FORT CAMPBELL, KY 42223-5318
(270) 798-8258
(270) 956-0444
Mailing address
650 JOEL DR, YOUNG EAGLE CLINIC, FORT CAMPBELL, KY 42223-5318
(270) 798-8258
(270) 956-0444
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0000068878
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000068878
NURSING LICENSE
TN
Enumeration date
01/07/2009
Last updated
01/07/2009
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