Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 2020011525 | MO |
N | 111NI0900X | Internist | 2020011525 | MO |
Y | 208D00000X | General Practice Physician | 2020011525 | MO |
NPI | 1003962697 |
---|---|
Provider Name | Dr. Nichole Gallegos Zehnder |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63108-1495 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200084478 | (05) | MO |