Basic Information
| Provider Information | |||||||||
| NPI: | 1750338174 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOHN | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSN, APRN-BC, ANP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RUZICKA | ||||||||
| OtherFirstName: | PATRICIA | ||||||||
| OtherMiddleName: | M | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MSN, APRN-BC, ANP | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12639 OLD TESSON RD | ||||||||
| Address2: | SUITE 115 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631282786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148490311 | ||||||||
| FaxNumber: | 3148494423 | ||||||||
| Practice Location | |||||||||
| Address1: | 1390 HIGHWAY 61 # B | ||||||||
| Address2: | G-1000 | ||||||||
| City: | FESTUS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630284137 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369337400 | ||||||||
| FaxNumber: | 6369337403 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 01/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 064101 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 500025716 | 01 | MO | RAILROAD MEDICARE | OTHER | 427295100 | 05 | MO | MEDICAID |