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General NPI Number Information
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NPI Number | 1457103806
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Entity Type | Individual
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Provider Name | TAMMY SUE JUERGENS FNP
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Gender | Female
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Dates
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Enumeration Date | 04/01/2024
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 700 W 2ND ST APT 221
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City | WASHINGONT
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State | MO
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Zip | 63090
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Country | US
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Telephone | 573-259-3418
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Fax |
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Provider Business Mailing Address
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Address Line | 901 E 5TH ST
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City | WASHINGTON
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State | MO
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Zip | 63090-3127
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2024010300
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License Number State | MO
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