Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 2021028498 | MO |
NPI | 1073186268 |
---|---|
Provider Name | Ashley Marie Babilonia |
First Address | Eureka, MO 63025-4119 |
Second Address | Saint Louis, MO 63110-1081 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2021 |
Last Update Date | 23/07/2021 |