Individual
NICHELLE ENATA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
660 S EUCLID AVE, SAINT LOUIS, MO 63110-1010
(314) 747-2835
Mailing address
660 S EUCLID AVE, SAINT LOUIS, MO 63110-1010
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
2020017990
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2020017990
MISSOURI DIVISION OF PROFESSIONAL REGISTRATION
MO
Enumeration date
10/13/2015
Last updated
07/09/2020
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