Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 2021041601 | MO |
NPI | 1053074997 |
---|---|
Provider Name | Faye Monahan |
First Address | Saint Louis, MO 63104-2547 |
Second Address | Saint Louis, MO 63141-6850 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2021 |
Last Update Date | 18/10/2021 |