Individual
MARY MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(636) 237-4132
Mailing address
615 SOUTH NEW BALLAS, ST. LOUIS, MO 63143
(314) 974-6874
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
2017008673
MO
Other
Enumeration date
05/12/2017
Last updated
05/12/2017
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