Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 2016006544 | MO |
NPI | 1023422599 |
---|---|
Provider Name | Ms. Leticia Sian Cross |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2014 |
Last Update Date | 24/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1023422599 | (05) | MO |