Individual
MRS. CAROLYN D PHILPOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GNP BC
Contact information
Practice address
3660 VISTA, ST LOUIS, MO 63110
(314) 977-6055
(314) 771-8575
Mailing address
3691 RUTGER AVE, PROVIDER ENROLLMENT, ST LOUIS, MO 63110
(314) 977-4440
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
069267
MO
363LG0600X
Gerontology Nurse Practitioner
069267
MO
Other
Enumeration date
03/10/2006
Last updated
03/17/2008
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