Individual
MISS TANIKA JOI PROWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4000 JENNINGS STATION RD, SAINT LOUIS, MO 63121-3323
(314) 679-7880
(314) 679-7846
Mailing address
111 S MERAMEC AVE, 41 S CENTRAL AVE, CLAYTON, MO 63105-1711
(314) 615-0600
(314) 615-8303
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
2006007421
MO
Other
Enumeration date
10/13/2011
Last updated
10/13/2011
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