Healthcare Provider Details

I. General information

NPI: 1043670466
Provider Name (Legal Business Name): STELLA WOHLFARTH FNP-C, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 S WOODS MILL RD STE 435S
CHESTERFIELD MO
63017-3408
US

IV. Provider business mailing address

PO BOX 740019
ATLANTA GA
30374-0019
US

V. Phone/Fax

Practice location:
  • Phone: 314-576-2394
  • Fax: 314-590-5937
Mailing address:
  • Phone: 312-733-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number468363
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number2021005093
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003274
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2021005093
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: