Provider Demographics
NPI:1356737266
Name:RADOSEVICH, FAITH JUANITA EULEMA (RN)
Entity type:Individual
Prefix:MS
First Name:FAITH
Middle Name:JUANITA EULEMA
Last Name:RADOSEVICH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 OLD JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-3428
Mailing Address - Country:US
Mailing Address - Phone:573-760-1700
Mailing Address - Fax:
Practice Address - Street 1:1180 OLD JACKSON RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3428
Practice Address - Country:US
Practice Address - Phone:573-760-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 376K00000X
MO2014033320183700000X
MO2019024085163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No183700000XPharmacy Service ProvidersPharmacy Technician
No376K00000XNursing Service Related ProvidersNurse's Aide