Individual
MRS. JO ANN BENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
3635 VISTA AVE, SAINT LOUIS, MO 63110-2539
(314) 577-8715
Mailing address
1201 SOUTH GRAND BLVD FL 5, ROOM 5H2018, SAINT LOUIS, MO 63104-2539
(314) 257-7272
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2011012310
MO
363LF0000X
Family Nurse Practitioner
209008834
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1174816797
NPI
MO
Enumeration date
05/16/2011
Last updated
12/09/2020
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