Healthcare Provider Details

I. General information

NPI: 1902830151
Provider Name (Legal Business Name): JUDITH MARIE JEGLIJEWSKI APRN, BC, MS, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 S WOODS MILL RD SUITE 410N
CHESTERFIELD MO
63017-3625
US

IV. Provider business mailing address

294 VILLAGE MEAD DR
BALLWIN MO
63021-6129
US

V. Phone/Fax

Practice location:
  • Phone: 314-469-6224
  • Fax: 314-469-0744
Mailing address:
  • Phone: 314-469-6224
  • Fax: 314-469-0744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN201534
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN046407
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number124987-21
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: