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Physician Assistants & Advanced Practice Nursing Providers Midwife, Certified Nurse

Provider NPI: 1457671604

Provider Information:
Gender: F
Not Sole Proprietor

Practice Location:
769 W TERRA LN  O FALLON, MO 63366-2432 US
Tel: 636-294-6441  Fax: 877-533-4456

Business Mailing Address:
769 W TERRA LN  O FALLON, MO 63366-2432 US
Tel: 636-294-6441  Fax: 877-533-4456

NPI Information:
NPI: 1457671604
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y367A00000XPhysician Assistants & Advanced Practice Nursing Providers
Midwife, Certified Nurse
N176B00000XOther Service Providers

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 367A00000X





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