Healthcare Provider Details

I. General information

NPI: 1477894368
Provider Name (Legal Business Name): NEPUTE DC WELLNESS CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2013
Last Update Date: 03/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 BAYLESS AVE
SAINT LOUIS MO
63123-7513
US

IV. Provider business mailing address

4225 BAYLESS AVE
SAINT LOUIS MO
63123-7513
US

V. Phone/Fax

Practice location:
  • Phone: 314-544-5600
  • Fax: 314-544-5696
Mailing address:
  • Phone: 314-544-5600
  • Fax: 314-544-5696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number069563
License Number StateMO

VIII. Authorized Official

Name: MR. ERIC ANTHONY NEPUTE
Title or Position: OWNER
Credential:
Phone: 314-544-5600