Healthcare Provider Details

I. General information

NPI: 1790989523
Provider Name (Legal Business Name): EDEN CHRISTINE OGDEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SECOND AND GULF ST.
LAMAR MO
64759
US

IV. Provider business mailing address

1197 W DADE 82
GOLDEN CITY MO
64748-7165
US

V. Phone/Fax

Practice location:
  • Phone: 417-681-5259
  • Fax: 417-681-5183
Mailing address:
  • Phone: 417-537-4956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number143355
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: