Individual
GRISMELDY E GOMEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
61 VILLAGE CIRCLE DR, WINFIELD, MO 63389-2053
(636) 322-8517
Mailing address
61 VILLAGE CIRCLE DR, WINFIELD, MO 63389-2053
(636) 322-8517
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2013026395
MO
363LP2300X
Primary Care Nurse Practitioner
Primary
53-78743-011
KS
Other
Enumeration date
04/29/2019
Last updated
06/15/2019
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