Healthcare Provider Details

I. General information

NPI: 1821403304
Provider Name (Legal Business Name): ON-LINE TRAINING CENTER,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 06/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1552 KNOLLWAY DR
FERGUSON MO
63135-1406
US

IV. Provider business mailing address

1552 KNOLLWAY DR
FERGUSON MO
63135-1406
US

V. Phone/Fax

Practice location:
  • Phone: 314-522-3077
  • Fax: 314-381-3311
Mailing address:
  • Phone: 314-522-3077
  • Fax: 314-381-3311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License Number
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License Number
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number
License Number StateMO
# 8
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number StateMO
# 9
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number StateMO
# 10
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number
License Number StateMO
# 11
Primary TaxonomyN
Taxonomy Code246YC3301X
TaxonomyHospital Based Coding Specialist
License Number
License Number StateMO
# 12
Primary TaxonomyN
Taxonomy Code246YC3302X
TaxonomyPhysician Office Based Coding Specialist
License Number
License Number StateMO
# 13
Primary TaxonomyN
Taxonomy Code2471R0002X
TaxonomyRadiation Therapy Radiologic Technologist
License Number
License Number StateMO
# 14
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO
# 15
Primary TaxonomyY
Taxonomy Code163WD1100X
TaxonomyPeritoneal Dialysis Registered Nurse
License Number
License Number StateMO

VIII. Authorized Official

Name: MS. DELORES GREGORY
Title or Position: DIRECTOR
Credential:
Phone: 314-522-3077