Organization
JULIE WITHWORTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RENITA J BARNES (CLINICAL DIRECTOR)
(314) 436-9300
Entity
Organization
Contact information
Practice address
916 OLIVE ST # 312, SAINT LOUIS, MO 63101-1459
(314) 436-9300
(314) 802-4477
Mailing address
916 OLIVE ST # 312, SAINT LOUIS, MO 63101-1459
(314) 436-9300
(314) 802-4477
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
2014036356
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1619372240
—
MO
Enumeration date
03/27/2015
Last updated
03/27/2015
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