Individual
DEMITRA MARIE NICHOALDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3015 N BALLAS RD, SAINT LOUIS, MO 63131-2329
(314) 996-5330
Mailing address
554 BRIARWYCK DR, BALLWIN, MO 63011-2456
(314) 660-0535
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
2014035076
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
2020019118
MO
Other
Enumeration date
04/27/2020
Last updated
08/01/2020
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