Individual
KATHERINE BLEISCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
621 S NEW BALLAS RD, SAINT LOUIS, MO 63141-8232
(314) 315-1494
Mailing address
2330 EAGLE PINES DR, SAINT CHARLES, MO 63303-8321
(314) 315-1494
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2016000966
MO
363LG0600X
Gerontology Nurse Practitioner
2016000966
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
46-2913068
—
MO
Enumeration date
01/18/2016
Last updated
01/18/2016
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