Individual
TIRAE LANISE ABERNATHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
16736 STANFORD PLACE DR, FLORISSANT, MO 63034-3213
(314) 629-7949
Mailing address
16736 STANFORD PLACE DR, FLORISSANT, MO 63034-3213
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
2023035283
MO
367A00000X
Advanced Practice Midwife
Primary
2023035282
MO
Other
Enumeration date
05/30/2023
Last updated
08/28/2023
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