Individual
PATRICIA ANN DETTENMEIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN CS
Contact information
Practice address
3660 VISTA, ST LOUIS, MO 63110
(314) 977-6190
(314) 268-5108
Mailing address
3691 RUTGER AVE, PROVIDER ENROLLMENT, ST LOUIS, MO 63110
(314) 977-4440
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
78947
MO
163WM0705X
Medical-Surgical Registered Nurse
78947
MO
363LA2200X
Adult Health Nurse Practitioner
78947
MO
Other
Enumeration date
03/11/2006
Last updated
01/09/2008
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