Individual
TANYA R MCNULTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRMA/CHW-C
Contact information
Practice address
5210 WREN AVE, SAINT LOUIS, MO 63120-1921
(314) 565-8006
Mailing address
5210 WREN AVE, SAINT LOUIS, MO 63120-1921
(314) 565-8006
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
17640
MO
202K00000X
Phlebology Physician
Primary
14594
MO
374J00000X
Doula
—
MO
Other
Enumeration date
02/12/2026
Last updated
02/12/2026
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