Individual
MS. VIRGINIA LORRAINE SEPICH CLEMONS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN CPNP
Contact information
Practice address
1465 S GRAND BLVD, ST LOUIS, MO 63104
(314) 577-5675
(314) 268-5111
Mailing address
3691 RUTGER AVE, PROVIDER ENROLLMENT, ST LOUIS, MO 63110
(314) 977-4440
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
104293
MO
163WX0601X
Otorhinolaryngology & Head-Neck Registered Nurse
104293
MO
363L00000X
Nurse Practitioner
Primary
20020346
MO
363LC0200X
Critical Care Medicine Nurse Practitioner
20020346
MO
363LP0200X
Pediatric Nurse Practitioner
20020346
MO
Other
Enumeration date
03/23/2006
Last updated
03/03/2020
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