MEDICARE: MS. CAROL V MASSMANN PNP

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	363L00000X	Nurse Practitioner	113735	MO

General Provider Information

NPI Number	:	1598782013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL V MASSMANN PNP

Provider Business Mailing Address
First Line	:	PO BOX 7412011
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60674-2011
Country	:	US
Telephone Number	:	314-454-2683
Fax Number	:	314-454-4633

Provider Business Practice Location Address
First Line	:	1 CHILDRENS PL
Second Line	:	DIV PED NEWBORN MEDICINE
City	:	SAINT LOUIS
State	:	MO
Zip	:	63110-1002
Country	:	US
Telephone Number	:	314-454-2683
Fax Number	:	314-454-4633

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	05/12/2026

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