Individual
CHARLES PHELAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
615 S NEW BALLAS RD, CREVE COEUR, MO 63141-8221
(314) 251-6000
Mailing address
615 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8221
(844) 735-4710
(636) 237-4074
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2015045012
MO
363LA2100X
Acute Care Nurse Practitioner
Primary
2024049964
MO
Other
Enumeration date
11/07/2024
Last updated
12/27/2024
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