Individual
SWE MYO
Active
Individual
SWE MYO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2012017206
MO
207R00000X
Internal Medicine Physician
Primary
A118620
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447480108
—
MO
05
—
193711001
—
AR
01
—
431560263
TRICARE
MO
01
—
P01077564
RR MCR
MO
Enumeration date
07/16/2009
Last updated
10/13/2025
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