Individual
MARY WITHOELTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
2630 STATE HIGHWAY K, OFALLON, MO 63368
(636) 980-5300
(636) 980-5344
Mailing address
PO BOX 959354, SAINT LOUIS, MO 63195-9354
(636) 980-5300
(636) 980-5344
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2019033706
MO
363LF0000X
Family Nurse Practitioner
2019033706
MO
Other
Enumeration date
09/20/2018
Last updated
09/18/2025
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