Individual
CONNIE D. DEETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2715 E BATTLEFIELD ST, SPRINGFIELD, MO 65804-3981
(417) 888-0298
Mailing address
2715 E BATTLEFIELD ST, SPRINGFIELD, MO 65804-3981
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
106702
MO
363LF0000X
Family Nurse Practitioner
Primary
2014010577
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942627237
—
MO
Enumeration date
03/25/2014
Last updated
01/21/2019
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