Healthcare Provider Details

I. General information

NPI: 1033197884
Provider Name (Legal Business Name): JANE CAROL VESEL DNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANE CAROL HENDRICKS-VESEL CNM

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EDGEWATER PT STE 200
LAKE ST LOUIS MO
63367-2954
US

IV. Provider business mailing address

PO BOX 1594 141 S. KINGS RD
LAKE SHERWOOD MO
63357-8594
US

V. Phone/Fax

Practice location:
  • Phone: 636-561-8088
  • Fax: 636-561-1405
Mailing address:
  • Phone: 618-292-6244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.386924-COA1
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number90856-030
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2016012520
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN109919
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number041-337801
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number14095-NM
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1410-033
License Number StateWI
# 8
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2017008466
License Number StateMO
# 9
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209-004836
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: