Individual
MELINDA JO WOLTERS LA SALLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, ACNP-BC
Contact information
Practice address
915 N GRAND BLVD, SAINT LOUIS, MO 63106-1621
(314) 652-4100
Mailing address
4100 FOREST PARK AVE APT 205, SAINT LOUIS, MO 63108-2885
(314) 709-8322
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2010031271
MO
363L00000X
Nurse Practitioner
2011015338
MO
363LA2100X
Acute Care Nurse Practitioner
Primary
2011015338
MO
Other
Enumeration date
08/01/2011
Last updated
04/04/2018
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