| NPI | 1184116014 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANETTA RENEE STOMER Co Owner 314-585-1002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: MO 2011023084) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MO 2004029626) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2020-03-28 |