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NPI Code Detail

MEDICARE: MS. FAITH JUANITA EULEMA RADOSEVICH RN

MEDICARE: MS. FAITH JUANITA EULEMA RADOSEVICH RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker
2183700000XPharmacy Technician2014033320MO
3376K00000XNurse's Aide
4163W00000XRegistered Nurse2019024085MO

General Provider Information

NPI Number : 1356737266
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. FAITH JUANITA EULEMA RADOSEVICH RN
Provider Business Mailing Address
First Line : 1180 OLD JACKSON RD
Second Line :
City : FARMINGTON
State : MO
Zip : 63640-3428
Country : US
Telephone Number : 573-760-1700
Fax Number :
Provider Business Practice Location Address
First Line : 1180 OLD JACKSON RD
Second Line :
City : FARMINGTON
State : MO
Zip : 63640-3428
Country : US
Telephone Number : 573-760-1700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2015
Last Update Date : 04/19/2021

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