Individual
MRS. JOANNE L THANAVARO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
114 N TAYLOR AVE, SAINT LOUIS, MO 63108-2102
(314) 534-8600
(314) 652-8138
Mailing address
114 N TAYLOR AVE, SAINT LOUIS, MO 63108-2102
(314) 534-8600
(314) 652-8138
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
068133
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1740475334
—
MO
Enumeration date
09/07/2007
Last updated
11/14/2016
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