Individual
LARISSA DIMELO VENHAUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP
Contact information
Practice address
4251 FOREST PARK AVE, SAINT LOUIS, MO 63108-2810
(314) 531-7526
Mailing address
1143 DAVE KAY ST, BREESE, IL 62230-3613
(618) 207-9986
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
2020026044
MO
Other
Enumeration date
10/22/2020
Last updated
10/22/2020
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