Healthcare Provider Details

I. General information

NPI: 1386023711
Provider Name (Legal Business Name): MRS. LINDA DUMAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 COLLIER CORPORATE PKWY
SAINT CHARLES MO
63303-6707
US

IV. Provider business mailing address

2101 COLLIER CORPORATE PKWY
SAINT CHARLES MO
63303-6707
US

V. Phone/Fax

Practice location:
  • Phone: 636-493-1408
  • Fax:
Mailing address:
  • Phone: 636-493-1408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number13501
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number13501
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number13501
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number13501
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number13501
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number13501
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number13501
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: