Basic Information
| Provider Information | |||||||||
| NPI: | 1124620893 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POPLAR | ||||||||
| FirstName: | MAUREEN | ||||||||
| MiddleName: | A | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 503643 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631503643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148395125 | ||||||||
| FaxNumber: | 3148395351 | ||||||||
| Practice Location | |||||||||
| Address1: | 11125 DUNN RD STE 204 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631366188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148395125 | ||||||||
| FaxNumber: | 3148395351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2020 | ||||||||
| LastUpdateDate: | 03/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 2020041026 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2100X | 226456-30 | WI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.