Healthcare Provider Details

I. General information

NPI: 1750164125
Provider Name (Legal Business Name): TOBEY RIGEL TUNG NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TOBEY RIGEL RUBIN

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6675 BUSINESS PKWY STE F
ELKRIDGE MD
21075-6349
US

IV. Provider business mailing address

7130 WYDOWN BLVD
SAINT LOUIS MO
63105-3021
US

V. Phone/Fax

Practice location:
  • Phone: 636-215-9215
  • Fax:
Mailing address:
  • Phone: 314-302-7868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG09230051
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: