Individual
MADISON NII
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 PARK AVE, SAINT LOUIS, MO 63104-3024
(559) 977-7759
Mailing address
1500 PARK AVE, SAINT LOUIS, MO 63104-3024
(559) 977-7759
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/05/2023
Last updated
03/26/2026
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