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General NPI Number Information
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NPI Number | 1811076763
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Entity Type | Individual
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Provider Name | NEDRA DIANN TWILLIE MD
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Gender | Female
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 10/24/2012
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Provider Practice Location Address
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Address Line | 415 BURKARTH RD STE D
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City | WARRENSBURG
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State | MO
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Zip | 64093-3101
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Country | US
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Telephone | 660-747-3141
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Fax | 660-747-7292
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Provider Business Mailing Address
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Address Line | 415 BURKARTH RD STE D
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City | WARRENSBURG
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State | MO
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Zip | 64093-3101
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Country | US
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Telephone | 660-747-3141
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Fax | 660-747-7292
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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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 103901
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License Number State | MO
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