Individual
GWENDOLYN WARREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
16105 MANCHESTER RD, ELLISVILLE, MO 63011-2001
(866) 825-3227
(484) 351-3800
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-0001
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
103915
MO
363LF0000X
Family Nurse Practitioner
103915
MO
Other
Enumeration date
09/22/2006
Last updated
10/27/2020
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