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1790015527
SANDRA LEE MITKOS
POTOSI, MO
NPI
1790015527
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: MO 2009036279)
Enumeration Date
2009-12-29
Last Update Date
2018-04-25
Business Address
-- SANDRA LEE MITKOS FNP
108 FRIZZELL ST
POTOSI, MO 63664-1505
Phone number: 573-438-5408
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Mailing Address
-- SANDRA LEE MITKOS FNP
300 HEALTH WAY DR
POTOSI, MO 63664-1420
Phone number: 573-438-5451
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