Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 000752 | MO |
Y | 222Z00000X | Podiatrist | 000752 | MO |
NPI | 1033122759 |
---|---|
Provider Name | Denise A Hardy |
First Address | St Louis, MO 63117 |
Second Address | St Louis, MO 63123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
113313 | BLUE SHIELD (01) | MO |
2700678 | UHC (01) | MO |
U68712 | (02) |