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Individual

STACIE D DETMER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
1011 BOWLES AVE STE 450, FENTON, MO 63026-0562
(314) 467-1500
(314) 467-1515
Mailing address
PO BOX 23340, SAINT LOUIS, MO 63156-3340
(314) 851-1000
(314) 851-4445

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2005018747
MO

Other

Enumeration date
10/10/2008
Last updated
05/21/2019
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