Individual
DIANE DENISE BLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1345 SMIZER MILL RD STE 1100, FENTON, MO 63026-7305
(636) 496-5023
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2015013958
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2015013958
LICENSE
MO
Enumeration date
07/01/2015
Last updated
11/19/2020
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