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Divine Redemption Llc
Family Nurse Practitioner in Bolivar, Missouri
NPI 1790536142

Divine Redemption Llc is a Family Nurse Practitioner based in Stockton, MO and is specialized in Family. Divine Redemption Llc practices in Bolivar, MO. The NPI Number for Divine Redemption Llc is 1790536142 and holds a License No. (Missouri).

The current practice location address for Divine Redemption Llc is 112 W Broadway, Bolivar, MO and can be reached out via phone at 417-296-4140 and via fax at 417-326-0022.

Location: 112 W Broadway, Bolivar, MO, 65785-8391
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1790536142
Provider Name
Divine Redemption Llc
Credential
Provider Entity Type
Organization
Address
112 W Broadway, Bolivar, MO, 65785-8391
Phone Number
417-296-4140
Fax Number
417-326-0022
Provider Enumeration Date
04/01/2024
Last Update Date
04/14/2024
institution
Provider Business Practice Location Address Details
Address
112 W Broadway
City
Bolivar
State
Missouri
Zip
65613
Phone Number
417-296-4140
Fax Number
417-326-0022
person
Provider Business Mailing Address Details
Address
112 W Broadway
City
Bolivar
State
Missouri
Zip
65613
Phone Number
417-296-4140
Fax Number
417-326-0022
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Family Medicine
Speciality
Addiction Medicine
Taxonomy
207QA0401X
License No.
()
Definition
A family medicine physician who specializes in the diagnosis and treatment of addictions.
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
363LF0000X
License No.
()
Definition
Definition to come...
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