Individual
MR. DONOVAN RANELL HYGRADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1430 OLIVE ST STE 400, SAINT LOUIS, MO 63103-2303
(314) 206-3700
Mailing address
1430 OLIVE ST STE 400, SAINT LOUIS, MO 63103-2303
(314) 206-3700
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0606246570
COMMUNITY SUPPORT SPECIALIST
MO
Enumeration date
10/03/2017
Last updated
10/03/2017
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