Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0401X | Internist - Addiction Medicine | 036-058285 | IL |
NPI | 1639213366 |
---|---|
Provider Name | Dr. Latanya C Tunstall-Robinson |
First Address | Saint Louis, MO 63108-2103 |
Second Address | Saint Louis, MO 63112-1757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 09/10/2015 |