Individual
GLORIA MICHELLE PAUL EDACHERIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
20 PROGRESS POINT PKWY STE 108, O FALLON, MO 63368
(636) 344-2400
(636) 344-2401
Mailing address
20 PROGRESS POINT PKWY STE 108, O FALLON, MO 63368-2207
(636) 344-2400
(636) 344-2401
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2011011839
MO
363LF0000X
Family Nurse Practitioner
Primary
2011011839
MO
Other
Enumeration date
09/14/2011
Last updated
03/12/2021
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