Healthcare Provider Details

I. General information

NPI: 1265495642
Provider Name (Legal Business Name): WOMAN TO WOMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906A GREENWOOD DR
POPLAR BLUFF MO
63901-2430
US

IV. Provider business mailing address

PO BOX 1087
POPLAR BLUFF MO
63902-1087
US

V. Phone/Fax

Practice location:
  • Phone: 573-776-7740
  • Fax: 573-776-7750
Mailing address:
  • Phone: 573-776-7740
  • Fax: 573-776-7750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number2003010408
License Number StateMO

VIII. Authorized Official

Name: MRS. POPPY DANIELS
Title or Position: OWNER
Credential: MD
Phone: 573-776-7740