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General NPI Number Information
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NPI Number | 1033419767
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Entity Type | Organization
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Legal Business Name | FT LEONARD WOOD WTU
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Dates
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Enumeration Date | 10/28/2010
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | BLD 312 ROOM 12
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City | FT LEONARD WOOD
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State | MO
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Zip | 65473
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Country | US
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Telephone | 573-586-0179
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Fax |
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Provider Business Mailing Address
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Address Line | 29690 MONROE ROAD 307
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City | SHELBINA
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State | MO
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Zip | 63468-2403
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Country | US
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Telephone | 573-586-0179
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Fax |
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Authorized Official
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Title or Position | RN NURSE CASE MANAGER
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Name | MS. TAMARA KAY GREENWELL
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Credential | RN
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Telephone | 573-586-0179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | 137163
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License Number State | MO
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