Healthcare Provider Details

I. General information

NPI: 1114160132
Provider Name (Legal Business Name): DANA RAYLENE URTON SOLE PROPRIETOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 W AUBERRY GRV
JAMESPORT MO
64648-7185
US

IV. Provider business mailing address

204 W AUBERRY GRV
JAMESPORT MO
64648-7185
US

V. Phone/Fax

Practice location:
  • Phone: 660-605-0042
  • Fax: 660-684-6423
Mailing address:
  • Phone: 660-605-0042
  • Fax: 660-684-6423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: