Individual
PIBI JEAN BOUDA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3320 MARSHALL AVE, SAINT LOUIS, MO 63114-4344
(314) 489-5537
Mailing address
3320 MARSHALL AVE, SAINT LOUIS, MO 63114-4344
(314) 489-5537
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
2023005006
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NA
—
MO
Enumeration date
02/13/2023
Last updated
04/26/2023
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