Basic Information
| Provider Information | |||||||||
| NPI: | 1902488315 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOLER | ||||||||
| FirstName: | MARY KATHERINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9051 W SWAN CIR | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631441647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134857434 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SAINT PETERS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633761659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369169000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2021 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 2021022252 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 367500000X | TBD | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.