Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 2014029119 | MO |
NPI | 1104226562 |
---|---|
Provider Name | Ms. Amelia Klueter |
First Address | Saint Louis, MO 63109-1131 |
Second Address | Saint Louis, MO 63110-1002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2014 |
Last Update Date | 03/09/2014 |