Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 109792 | MO |
N | 208000000X | Pediatrician | 109792 | MO |
NPI | 1174596860 |
---|---|
Provider Name | Laura A Esswein |
First Address | Saint Louis, MO 63126-1829 |
Second Address | Saint Louis, MO 63126-1829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2006 |
Last Update Date | 29/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1174596860 | (05) | MO |
G39451 | (02) | MO |
P01280989 | RAILROAD MEDICARE (01) | MO |