Healthcare Provider Details

I. General information

NPI: 1861928244
Provider Name (Legal Business Name): GINA MARIE SCHNURBUSCH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5551 WINGHAVEN BLVD STE 290
O FALLON MO
63368-3629
US

IV. Provider business mailing address

426 MORNINGSIDE DR
SAINT PETERS MO
63376-4003
US

V. Phone/Fax

Practice location:
  • Phone: 636-695-2575
  • Fax: 314-590-5938
Mailing address:
  • Phone: 314-220-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016004339
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: