Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 2019039994 | MO |
NPI | 1083233274 |
---|---|
Provider Name | Gina Hart |
First Address | Saint Louis, MO 63119-3305 |
Second Address | Saint Louis, MO 63141-5047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2020 |
Last Update Date | 26/05/2020 |