Individual
DESIREE WICKENHAUSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
11133 DUNN RD, SAINT LOUIS, MO 63136-6163
(314) 203-3041
Mailing address
11133 DUNN RD, SAINT LOUIS, MO 63136-6163
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041419907
IL
163W00000X
Registered Nurse
2011022892
MO
367500000X
Certified Registered Nurse Anesthetist
2017002698
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
209016063
IL
Other
Enumeration date
08/30/2016
Last updated
05/31/2024
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