Healthcare Provider Details

I. General information

NPI: 1538151097
Provider Name (Legal Business Name): CAROLINE WERNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 SHACKELFORD RD
FLORISSANT MO
63031-4369
US

IV. Provider business mailing address

PO BOX 955534
SAINT LOUIS MO
63195-5534
US

V. Phone/Fax

Practice location:
  • Phone: 314-921-4420
  • Fax: 314-921-6086
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR1F05
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: