Healthcare Provider Details

I. General information

NPI: 1841980216
Provider Name (Legal Business Name): LAURA HELENE PELLIZZARI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 CUNNINGHAM AVE
JOPLIN MO
64804-1542
US

IV. Provider business mailing address

8449 GOLDFINCH RD
NEOSHO MO
64850-7173
US

V. Phone/Fax

Practice location:
  • Phone: 417-782-7500
  • Fax:
Mailing address:
  • Phone: 641-233-7059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2026033710
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: