Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 2021027713 | MO |
NPI | 1194398446 |
---|---|
Provider Name | Ms. Corie Rose Hasler |
First Address | Saint Louis, MO 63143-1421 |
Second Address | Saint Louis, MO 63110-1002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2021 |
Last Update Date | 22/07/2021 |