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General NPI Number Information
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NPI Number | 1528384823
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Entity Type | Individual
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Provider Name | MANDY R D'AGOSTINO FNP-C
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Gender | Female
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Dates
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Enumeration Date | 04/12/2010
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Last Update Date | 04/23/2021
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Provider Practice Location Address
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Address Line | 2230 S SPRINGFIELD AVE STE H
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City | BOLIVAR
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State | MO
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Zip | 65613-9133
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Country | US
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Telephone | 417-777-4800
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Fax | 417-326-7300
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Provider Business Mailing Address
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Address Line | 2230 S SPRINGFIELD AVE STE H
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City | BOLIVAR
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State | MO
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Zip | 65613-9133
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Country | US
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Telephone | 417-777-4800
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Fax | 417-326-7300
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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 | 20030009032
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License Number State | MO
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