Healthcare Provider Details

I. General information

NPI: 1245385715
Provider Name (Legal Business Name): RAMONA B. CHEBLI ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1390 US HIGHWAY 61 SUITE 3300
FESTUS MO
63028-4137
US

IV. Provider business mailing address

12855 N 40 DR SUITE 300
SAINT LOUIS MO
63141-8657
US

V. Phone/Fax

Practice location:
  • Phone: 636-931-6302
  • Fax: 636-933-3609
Mailing address:
  • Phone: 314-880-6162
  • Fax: 314-997-3248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number130564
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: