Individual
MRS. LACONTE RANDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1225 LAKEVIEW AVE, SAINT LOUIS, MO 63138
(314) 813-4100
Mailing address
1225 LAKEVIEW AVE, SAINT LOUIS, MO 63138-3033
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2017000766
MO
Other
Enumeration date
07/14/2017
Last updated
07/14/2017
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