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General NPI Number Information
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NPI Number | 1467490870
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Entity Type | Individual
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Provider Name | JESSICA ELIZABETH NIEHOFF R.N., A.N.P
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Gender | Female
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 104 SARAH ANN BLVD
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City | TROY
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State | MO
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Zip | 63379-2038
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Country | US
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Telephone | 636-528-5281
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Fax | 636-528-8471
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Provider Business Mailing Address
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Address Line | 3585 N MOORE SCHOOL RD
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City | TROY
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State | MO
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Zip | 63379-4415
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Country | US
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Telephone | 636-528-5281
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Fax | 636-528-8471
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 151590
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License Number State | MO
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