Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 2015042084 | MO |
NPI | 1003271040 |
---|---|
Provider Name | Mrs. Maurine Free Huber |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1014 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2015 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
420030428 | (05) | MO |