Individual
MRS. COURTNEY PAIGE WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
2650 OLIVE ST, SAINT LOUIS, MO 63103-1489
(314) 533-8200
Mailing address
2650 OLIVE ST, SAINT LOUIS, MO 63103-1424
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2020019958
MO
Other
Enumeration date
07/06/2020
Last updated
05/27/2021
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