Basic Information
| Provider Information | |||||||||
| NPI: | 1538343744 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PREUSS | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1551 WALL ST | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | SAINT CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633033539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6366692268 | ||||||||
| FaxNumber: | 6366692401 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 1ST CAPITOL DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SAINT CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633012880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6366692332 | ||||||||
| FaxNumber: | 6366692375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/24/2007 | ||||||||
| LastUpdateDate: | 05/23/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0705X | 110226 | MO | Y | Nursing Service Providers | Registered Nurse | Medical-Surgical |
ID Information
| ID | Type | State | Issuer | Description | 110226 | 01 | MO | MO RN LICENSE | OTHER |