Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2006000316 | MO |
NPI | 1124066592 |
---|---|
Provider Name | Dr. Anne Catherine Roulo |
First Address | Saint Louis, MO 63116-2216 |
Second Address | Saint Louis, MO 63109-2538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 08/07/2007 |