Provider Demographics
NPI:1932450046
Name:STEELE, AZUCENA PUERTO (BSN, RN, CRNI)
Entity Type:Individual
Prefix:
First Name:AZUCENA
Middle Name:PUERTO
Last Name:STEELE
Suffix:
Gender:F
Credentials:BSN, RN, CRNI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 N SECOND ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MO
Mailing Address - Zip Code:64735
Mailing Address - Country:US
Mailing Address - Phone:660-890-7269
Mailing Address - Fax:660-885-5420
Practice Address - Street 1:1600 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-1192
Practice Address - Country:US
Practice Address - Phone:660-890-7269
Practice Address - Fax:660-885-5420
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111973163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO111973OtherSTATEBOARD OF NURSING
MA43359OtherINFUSION NURSES SOCIETY