Healthcare Provider Details

I. General information

NPI: 1184481079
Provider Name (Legal Business Name): BRITTANY NICOLE OPSOMER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 KINGSHIGHWAY ST STE 5
ROLLA MO
65401-2981
US

IV. Provider business mailing address

105 MOLTER CT
FORT LEONARD WOOD MO
65473-8019
US

V. Phone/Fax

Practice location:
  • Phone: 573-366-9857
  • Fax:
Mailing address:
  • Phone: 419-957-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.467109
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: