Healthcare Provider Details

I. General information

NPI: 1942433396
Provider Name (Legal Business Name): TAMARA SCAIFE A.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 MCKELVEY RD
BRIDGETON MO
63044-2527
US

IV. Provider business mailing address

11155 DUNN RD SUITE 304E
SAINT LOUIS MO
63136-6150
US

V. Phone/Fax

Practice location:
  • Phone: 314-741-0911
  • Fax: 314-741-0501
Mailing address:
  • Phone: 314-741-0911
  • Fax: 314-653-3671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209014932
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number153644
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: