Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 2009034349 | MO |
NPI | 1184952525 |
---|---|
Provider Name | Ms. Stephanie Lynn Rader |
First Address | Saint Louis, MO 63104-1003 |
Second Address | Saint Louis, MO 63104-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2009 |
Last Update Date | 12/11/2020 |