| NPI | 1689451320 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTA NICOLE NELSON Dpm/Owner 314-739-7100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 213E00000X Podiatrist |
| 213ES0103X Podiatrist, Foot & Ankle Surgery | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2023-09-14 |
| Last Update Date | 2023-09-14 |