Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 2010021063 | MO |
Y | 207VX0201X | Gynecologic Oncologist | 2018006396 | MO |
NPI | 1003136151 |
---|---|
Provider Name | Shannon Michelle Grabosch |
First Address | Saint Louis, MO 63117-1858 |
Second Address | Saint Louis, MO 63117-1858 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2010 |
Last Update Date | 14/01/2021 |