Individual
DESIRAE RENEE WELBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
12700 SOUTHFORK RD STE 260, SAINT LOUIS, MO 63128-3288
(314) 543-5270
Mailing address
12700 SOUTHFORK RD STE 260, SAINT LOUIS, MO 63128-3288
(314) 543-5270
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
209012412
IL
363LA2200X
Adult Health Nurse Practitioner
Primary
2013036176
MO
Other
Enumeration date
10/01/2013
Last updated
09/23/2021
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