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General NPI Number Information
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NPI Number | 1427051069
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Entity Type | Organization
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Legal Business Name | PHELPS COUNTY CLERK
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 08/15/2007
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Provider Practice Location Address
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Address Line | 200 N MAIN ST STE G51
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City | ROLLA
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State | MO
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Zip | 65401-3070
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Country | US
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Telephone | 573-458-6010
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Fax | 573-458-6060
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Provider Business Mailing Address
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Address Line | 200 N MAIN ST STE G51
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City | ROLLA
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State | MO
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Zip | 65401-3070
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Country | US
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Telephone | 573-458-6010
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Fax | 573-458-6060
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JOSEPHINE P WALTMAN
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Credential | MS, MED, CPNP
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Telephone | 573-458-6010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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License Number | N/A
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License Number State | MO
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