Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 2018009359 | MO |
NPI | 1073098117 |
---|---|
Provider Name | Alecia Miesner |
First Address | Chesterfield, MO 63017-5740 |
Second Address | Chesterfield, MO 63017-5740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2018 |
Last Update Date | 20/05/2021 |