Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 2020032248 | MO |
NPI | 1023619285 |
---|---|
Provider Name | Jennifer Lee Speiser |
First Address | Saint Louis, MO 63141-6311 |
Second Address | Saint Louis, MO 63141-6311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2020 |
Last Update Date | 04/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2020032248 | LICENSE (01) | MO |