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Individual

MICHAEL JASON DEAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RN ANP

Contact information

Practice address
1400 PRESIDENTS LANDING DR, O FALLON, MO 63366-8475
(636) 866-1293
Mailing address
1400 PRESIDENTS LANDING DR, O FALLON, MO 63366-8475
(636) 866-1293

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
2000167996
MO
363L00000X
Nurse Practitioner
53-74934-022
KS
363LA2200X
Adult Health Nurse Practitioner
Primary
2000167996
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
177840901
TX
05
200622300A
KS
Enumeration date
03/10/2006
Last updated
11/19/2014
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