Basic Information
| Provider Information | |||||||||
| NPI: | 1508372608 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VERETT | ||||||||
| FirstName: | MACAELA | ||||||||
| MiddleName: | DAWN | ||||||||
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| Credential: | AGPCNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9620 CHAMBLIN DR | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631236208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143718192 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3635 VISTA AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631102539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145778000 | ||||||||
| FaxNumber: | 3145778000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2017 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 2016027064 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.