Individual
MIA DAVETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
4905 MEXICO RD., STE 400, SAINT PETERS, MO 63376
(314) 590-3721
Mailing address
4905 MEXICO RD., STE 400, SAINT PETERS, MO 63376
(314) 590-3721
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2023004707
MO
Other
Enumeration date
04/21/2023
Last updated
04/21/2023
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