Individual
MRS. JENNIFER LYNN TIETJEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
12348 OLD TESSON RD, ST 160, SAINT LOUIS, MO 63128-2251
(314) 467-3800
Mailing address
271 ARBOR TRAILS DR, BALLWIN, MO 63021-3308
(314) 753-3982
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
2013006671
MO
Other
Enumeration date
03/28/2013
Last updated
07/22/2016
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