Healthcare Provider Details

I. General information

NPI: 1124138201
Provider Name (Legal Business Name): SUSAN J MENNER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 12/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 S WOODS MILL RD
CHESTERFIELD MO
63017
US

IV. Provider business mailing address

940 WEST PORT PLAZA STE 270
ST LOUIS MO
63146
US

V. Phone/Fax

Practice location:
  • Phone: 317-205-6917
  • Fax:
Mailing address:
  • Phone: 314-453-0600
  • Fax: 314-453-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number102097
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: