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General NPI Number Information
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NPI Number | 1043176696
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Entity Type | Organization
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Legal Business Name | OLDE TOWNE MEDICAL COMPANY, LLC
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 27 W SAINT JOSEPH ST
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City | PERRYVILLE
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State | MO
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Zip | 63775-1344
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Country | US
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Telephone | 573-768-2399
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Fax |
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Provider Business Mailing Address
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Address Line | 27 W SAINT JOSEPH ST
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City | PERRYVILLE
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State | MO
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Zip | 63775-1344
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Country | US
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Telephone | 573-768-2399
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Fax |
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Authorized Official
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Title or Position | FNP-C
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Name | RACHEL DIBOOGLU
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Credential | FNP-C
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Telephone | 573-768-2436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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