Individual
JERMAINE ORLANDO MATTHEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
4700 N HILLS LN, SAINT LOUIS, MO 63121-1030
(314) 591-8801
Mailing address
4700 N HILLS LN, SAINT LOUIS, MO 63121-1030
(314) 591-8801
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2007012721
MO
343900000X
Non-emergency Medical Transport (VAN)
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Other
Enumeration date
07/16/2007
Last updated
12/06/2023
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