Individual
SPENCER JOHN MARES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C, AGACNP-BC
Contact information
Practice address
100 MEDICAL PLZ, LAKE SAINT LOUIS, MO 63367-1366
(636) 625-5200
Mailing address
50 MEADOW RUN CT, SAINT PETERS, MO 63303-5805
(636) 485-3683
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
2023006109
MO
363LF0000X
Family Nurse Practitioner
2018001739
MO
363LF0000X
Family Nurse Practitioner
277.000663
IL
Other
Enumeration date
01/11/2018
Last updated
03/10/2023
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