MEDICARE: MS. SAMRA FAJIC ACNP

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	363LG0600X	Gerontology Nurse Practitioner	2020004945	MO
2	363L00000X	Nurse Practitioner	2020004945	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417589052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SAMRA FAJIC ACNP

Provider Business Mailing Address
First Line	:	522 N NEW BALLAS RD STE 240
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6819
Country	:	US
Telephone Number	:	314-567-5100
Fax Number	:	314-362-9878

Provider Business Practice Location Address
First Line	:	522 N NEW BALLAS RD STE 240
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-6819
Country	:	US
Telephone Number	:	314-567-5100
Fax Number	:	314-567-3387

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

Provider Enumeration Date	:	02/11/2020
Last Update Date	:	10/17/2023

Similar Medicare Providers

1609832476 — JASON B AMATO M.D.
Practice Location Address:

522 N NEW BALLAS RD , STE 203
SAINT LOUIS, MO
63141-6819

Practice Phone: 314-569-3323
Practice Fax: 314-569-3358

1285176297 — CHRISTINE DONAHUE DILL FNP-BC
Practice Location Address:

522 N NEW BALLAS RD STE 203
SAINT LOUIS, MO
63141-6819

Practice Phone: 314-569-3323
Practice Fax:

1093271843 — MISS HALLIE RAE FANNING PHARM. D
Practice Location Address:

522 N NEW BALLAS RD STE 206
SAINT LOUIS, MO
63141-6819

Practice Phone: 314-499-1227
Practice Fax: 314-499-1228

1174267660 — DR. MARY OLSON PHD
Practice Location Address:

522 N NEW BALLAS RD STE 201
SAINT LOUIS, MO
63141-6819

Practice Phone: 314-833-4210
Practice Fax:

1659073658 — KATHARINE PROPST PA-C
Practice Location Address:

522 N NEW BALLAS RD STE 203
SAINT LOUIS, MO
63141-6819

Practice Phone: 314-569-3323
Practice Fax:

1154893071 — LOCAL HEALTH SPECIALTY
Practice Location Address:

522 N NEW BALLAS RD STE 206
ST. LOUIS, MO
63141-6819

Practice Phone: 314-499-1227
Practice Fax: 314-499-1228

Directions to “ MS. SAMRA FAJIC ACNP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.