MEDICARE: MRS. JUANITA SHIMARIS BLOCKTON RN

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	2017029135	MO

General Provider Information

NPI Number	:	1710626387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUANITA SHIMARIS BLOCKTON RN

Provider Business Mailing Address
First Line	:	10562 MURAT DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-4524
Country	:	US
Telephone Number	:	314-216-1072
Fax Number	:

Provider Business Practice Location Address
First Line	:	10562 MURAT DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-4524
Country	:	US
Telephone Number	:	314-216-1072
Fax Number	:

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

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	06/01/2022

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