Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 2018030046 | MO |
NPI | 1003396334 |
---|---|
Provider Name | Rachel Erin Obrien |
First Address | Saint Louis, MO 63110-1035 |
Second Address | Saint Louis, MO 63110-1035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2018 |
Last Update Date | 16/08/2018 |