Healthcare Provider Details

I. General information

NPI: 1902172521
Provider Name (Legal Business Name): DEBORAH A MONJE RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12303 DEPAUL DR
BRIDGETON MO
63044-2588
US

IV. Provider business mailing address

6462 MILL VIEW DR
BYRNES MILL MO
63051-1295
US

V. Phone/Fax

Practice location:
  • Phone: 314-344-6000
  • Fax:
Mailing address:
  • Phone: 636-533-4035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2001021460
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: