Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 079617 | MO |
NPI | 1033380183 |
---|---|
Provider Name | Linda K Grossglauser |
First Address | Saint Louis, MO 63119-1316 |
Second Address | Saint Louis, MO 63128-2106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2008 |
Last Update Date | 17/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
950005 | (05) | MO |