Basic Information
| Provider Information | |||||||||
| NPI: | 1699002527 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARDINAL GLENNON CHILDREN'S HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1465 S GRAND BLVD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631041003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145775666 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1465 S GRAND BLVD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631041003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145775666 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2009 | ||||||||
| LastUpdateDate: | 11/13/2009 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | SHANNON | ||||||||
| AuthorizedOfficialMiddleName: | LANEE | ||||||||
| AuthorizedOfficialTitleorPosition: | PEDIATRIC NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 6189751607 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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| AuthorizedOfficialCredential: | RN, MSN, CPNP | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | MO151383 | MO | Y | Hospitals | General Acute Care Hospital | Children |
No ID Information.