Individual
MS. MARCELLA M PETZCHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3660 VISTA AVE, SUITE 207, SAINT LOUIS, MO 63110-2540
(314) 977-6100
(314) 977-6137
Mailing address
3691 RUTGER AVE, PROVIDER ENROLLMENT, ST LOUIS, MO 63110
(314) 977-4440
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
051062
MO
363LA2200X
Adult Health Nurse Practitioner
Primary
051062
MO
363LP2300X
Primary Care Nurse Practitioner
051062
MO
363LW0102X
Women's Health Nurse Practitioner
051062
MO
Other
Enumeration date
04/03/2006
Last updated
08/04/2025
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