Individual
HALEY BANTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
10010 KENNERLY RD, SAINT LOUIS, MO 63128-2106
(314) 525-1328
Mailing address
10010 KENNERLY ROAD, 3 SOUTHBRIDGE, SAINT LOUIS, MO 63128
(314) 525-1328
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2021009043
MO
Other
Enumeration date
03/31/2020
Last updated
03/11/2024
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