Healthcare Provider Details

I. General information

NPI: 1073202016
Provider Name (Legal Business Name): MRS. PATRICIA ANN HOLSCHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 06/04/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 BROCKWELL DR
O FALLON MO
63368-8370
US

IV. Provider business mailing address

832 BROCKWELL DR
O FALLON MO
63368-8370
US

V. Phone/Fax

Practice location:
  • Phone: 314-368-4842
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number144153
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: