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NPI Code Detail

MEDICARE: JUDITH L HUSTERMANN NP

MEDICARE: JUDITH L HUSTERMANN NP
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
1363L00000XNurse Practitioner2010041395MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1128186OTHERMORN LICENSE
22010041395OTHERMONP LICENSE

General Provider Information

NPI Number : 1255639019
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDITH L HUSTERMANN NP
Provider Business Mailing Address
First Line : PO BOX 955534
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63195-5534
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 18800 SCHNUCKS DR STE B
Second Line :
City : WARRENTON
State : MO
Zip : 63383-1121
Country : US
Telephone Number : 636-456-3414
Fax Number : 636-456-7238
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2011
Last Update Date : 06/12/2024

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