Organization
DONNA JEANNE ERISMAN
Active
Other names
New Life
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DONNA JEANNE ERISMAN (OWNER)
(417) 624-4754
Entity
Organization
Contact information
Practice address
3420 TANA ST, JOPLIN, MO 64804-5450
(417) 624-4754
Mailing address
3420 TANA ST, JOPLIN, MO 64804-5450
(417) 624-4754
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
SOCIAL SECURITY NUMBER
MO
Enumeration date
12/14/2006
Last updated
05/21/2020
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