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Individual

TANIS BAST

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1935 PRAIRIE DELL RD STE 500, UNION, MO 63084-4329
(636) 649-3080
(636) 649-3081
Mailing address
PO BOX 776084, CHICAGO, IL 60677-6084
(636) 649-3080
(636) 649-3081

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2016023261
MO

Other

Enumeration date
02/04/2016
Last updated
06/25/2024
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