Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207VE0102X | Reproductive Endocrinologist | 036150712 | IL |
Y | 207VE0102X | Reproductive Endocrinologist | 2019033095 | MO |
NPI | 1134484082 |
---|---|
Provider Name | Violet Klenov |
First Address | Saint Louis, MO 63141-8232 |
Second Address | St. Louis, MO 63141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2012 |
Last Update Date | 30/09/2019 |