Individual
MRS. ELLEN ROSE WERTENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
510 S KINGSHIGHWAY BLVD, DEPT RADIOLOGY, SAINT LOUIS, MO 63110-1016
(314) 362-7200
(314) 747-4189
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(314) 362-7200
(314) 747-4189
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2013005294
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220024483
—
MO
Enumeration date
02/20/2013
Last updated
04/17/2025
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