Individual
MS. SAMRA FAJIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
522 N NEW BALLAS RD STE 240, SAINT LOUIS, MO 63141-6819
(314) 567-5100
(314) 567-3387
Mailing address
522 N NEW BALLAS RD STE 240, SAINT LOUIS, MO 63141-6819
(314) 567-5100
(314) 362-9878
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2020004945
MO
363LG0600X
Gerontology Nurse Practitioner
2020004945
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420081760
—
MO
Enumeration date
02/11/2020
Last updated
10/17/2023
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