Healthcare Provider Details

I. General information

NPI: 1881925725
Provider Name (Legal Business Name): DENISE L GEBHARDT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 E MAIN ST
FESTUS MO
63028-1952
US

IV. Provider business mailing address

227 E MAIN ST
FESTUS MO
63028-1952
US

V. Phone/Fax

Practice location:
  • Phone: 636-931-2700
  • Fax: 636-296-0102
Mailing address:
  • Phone: 636-931-2700
  • Fax: 636-296-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number130444
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: