MEDICARE: HALEY GENDER PSCHIRRER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	436888	IL
2	367500000X	Certified Registered Nurse Anesthetist	209029793	IL

General Provider Information

NPI Number	:	1174231401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY GENDER PSCHIRRER

Provider Business Mailing Address
First Line	:	3518 HUMPHREY ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-2723
Country	:	US
Telephone Number	:	309-224-3628
Fax Number	:

Provider Business Practice Location Address
First Line	:	3518 HUMPHREY ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-2723
Country	:	US
Telephone Number	:	309-224-3628
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2022
Last Update Date	:	06/05/2024

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