Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 20020346 | MO |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 20020346 | MO |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 20020346 | MO |
NPI | 1013976356 |
---|---|
Provider Name | Ms. Virginia Lorraine Sepich Clemons |
First Address | St Louis, MO 63110 |
Second Address | St Louis, MO 63104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 03/03/2020 |