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Individual

MALINDA A PHENIX

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
5819 HODIAMONT AVE, SAINT LOUIS, MO 63136-3601
(314) 757-1191
Mailing address
5819 HODIAMONT AVE, SAINT LOUIS, MO 63136-3601
(314) 757-1191

Taxonomy

Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
20151139
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
K208033007
MO
Enumeration date
06/16/2020
Last updated
06/16/2020
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