Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 102677 | MO |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 102677 | MO |
N | 207VG0400X | Gynecologist | 102677 | MO |
NPI | 1659382216 |
---|---|
Provider Name | Mary T Mclennan |
First Address | Saint Louis, MO 63117-1811 |
Second Address | Saint Louis, MO 63117-1856 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 18/01/2021 |