Basic Information
Provider Information
NPI: 1609987205
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCMANEMY
FirstName: JULIE
MiddleName: KATHRYN
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 CHILDRENS PL
Address2: C B 8116
City: SAINT LOUIS
State: MO
PostalCode: 631101002
CountryCode: US
TelephoneNumber: 3144542341
FaxNumber: 3144544345
Practice Location
Address1: 1 CHILDRENS PL
Address2:  
City: SAINT LOUIS
State: MO
PostalCode: 631101002
CountryCode: US
TelephoneNumber: 3144542341
FaxNumber: 3144544345
Other Information
ProviderEnumerationDate: 08/31/2006
LastUpdateDate: 07/20/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0204X2003013352MOY Allopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine

No ID Information.


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