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Individual

DR. COLLEEN PATRICIA MCNICHOLAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO

Contact information

Practice address
4901 FOREST PARK AVE STE 710, STE 710, SAINT LOUIS, MO 63108-1402
(314) 362-4211
(314) 362-0049
Mailing address
660 S EUCLID AVE, C B 8064, SAINT LOUIS, MO 63110-1010
(314) 454-7882
(314) 222-6245

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
2011003938
MO
207VG0400X
Gynecology Physician
Primary
2011003938
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1962664730
MO
05
ENROLLED
IL
Enumeration date
07/01/2008
Last updated
01/24/2018
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