Individual
MR. GREGORY CHARLES WOMACK SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
4929 WISE AVE, SAINT LOUIS, MO 63110-1418
(314) 814-4388
Mailing address
4929 WISE AVE, SAINT LOUIS, MO 63110-1418
(314) 814-4388
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2012013815
MO
Other
Enumeration date
10/29/2019
Last updated
10/29/2019
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