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General NPI Number Information
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NPI Number | 1245522655
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Entity Type | Organization
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Legal Business Name | HOMETOWN HEALTHCARE OF DESOTO LLC
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 05/04/2011
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Provider Practice Location Address
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Address Line | 106 EASTON ST
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City | DE SOTO
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State | MO
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Zip | 63020-1706
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Country | US
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Telephone | 636-337-5522
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Fax | 636-337-5525
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Provider Business Mailing Address
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Address Line | 106 EASTON ST
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City | DE SOTO
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State | MO
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Zip | 63020-1706
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Country | US
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Telephone | 636-337-5522
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Fax | 636-337-5525
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA F AMES-POWERS
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Credential | FNP-BC
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Telephone | 636-337-5522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 126672
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License Number State | MO
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