Healthcare Provider Details

I. General information

NPI: 1437495850
Provider Name (Legal Business Name): JANA LYNN FUEHRING RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2012
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E HOSPITAL DR
SWEET SPRINGS MO
65351-2229
US

IV. Provider business mailing address

1005 S BISMARK ST PO BOX 853
CONCORDIA MO
64020-9366
US

V. Phone/Fax

Practice location:
  • Phone: 660-335-7416
  • Fax:
Mailing address:
  • Phone: 816-838-0531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2005032828
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: