Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 2001020199 | MO |
N | 111NN1001X | Nutrition | 2001020199 | MO |
NPI | 1538295290 |
---|---|
Provider Name | Mrs. Caroline Anne Seymour |
First Address | Saint Louis, MO 63129-1098 |
Second Address | Saint Louis, MO 63129-1098 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2007 |
Last Update Date | 19/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
174832 | ANTHEM BLUE CROSS BLUE SH (01) | MO |