Provider Demographics
NPI:1740803758
Name:ST ORES, BILLIE JO
Entity Type:Individual
Prefix:
First Name:BILLIE JO
Middle Name:
Last Name:ST ORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1553 380TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:IA
Mailing Address - Zip Code:52727-9612
Mailing Address - Country:US
Mailing Address - Phone:563-349-4819
Mailing Address - Fax:
Practice Address - Street 1:1553 380TH AVE
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:IA
Practice Address - Zip Code:52727-9612
Practice Address - Country:US
Practice Address - Phone:563-349-4819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA117992163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health