Individual
VIJAYALAKSHMI DIVAKARAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP, BC
Contact information
Practice address
915 N GRAND BLVD, SAINT LOUIS, MO 63106-1621
(314) 652-4100
Mailing address
915 N GRAND BLVD, SAINT LOUIS, MO 63106-1621
(314) 652-4100
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2002031628
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
424053700
—
MO
Enumeration date
12/20/2007
Last updated
09/10/2025
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