Healthcare Provider Details

I. General information

NPI: 1619709276
Provider Name (Legal Business Name): NANCY LYNN MENKE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 08/14/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3657 BAPTIST PARK ROAD
MAPAVILLE MO
63065
US

IV. Provider business mailing address

PO BOX 147
HEMATITE MO
63047-0147
US

V. Phone/Fax

Practice location:
  • Phone: 636-931-0080
  • Fax:
Mailing address:
  • Phone: 314-223-9314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number046174
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: