Healthcare Provider Details

I. General information

NPI: 1932584075
Provider Name (Legal Business Name): LAURIE A GILTNER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2299 TECHNOLOGY DR STE 320
O FALLON MO
63368-7341
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 636-695-0535
  • Fax: 636-695-0537
Mailing address:
  • Phone: 636-695-0535
  • Fax: 636-695-0537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2015012078
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015012078
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: