Individual
LAVADA JEAN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
12303 DE PAUL DR, BRIDGETON, MO 63044-2512
(314) 317-0600
(314) 317-0606
Mailing address
12101 WOODCREST EXECUTIVE DR, SUITE 210, SAINT LOUIS, MO 63141-5047
(314) 317-0600
(314) 317-0606
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2090200077
IL
363LA2200X
Adult Health Nurse Practitioner
150496
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1164691945
—
IL
05
—
1164691945
—
MO
Enumeration date
02/26/2008
Last updated
04/20/2020
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