Healthcare Provider Details

I. General information

NPI: 1477909166
Provider Name (Legal Business Name): JULIA SLAVIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7068 S OUTER 364
O FALLON MO
63368-7757
US

IV. Provider business mailing address

4542 FERRER DR
SAINT LOUIS MO
63129-3741
US

V. Phone/Fax

Practice location:
  • Phone: 636-240-6100
  • Fax:
Mailing address:
  • Phone: 314-703-3918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number298295
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number2016003746
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number2016003746
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: