Healthcare Provider Details

I. General information

NPI: 1316311525
Provider Name (Legal Business Name): LEVET DUPREE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JEFFERSON BARRACKS DR
SAINT LOUIS MO
63125-4181
US

IV. Provider business mailing address

4947 SAINT LOUIS AVE
SAINT LOUIS MO
63115-1626
US

V. Phone/Fax

Practice location:
  • Phone: 314-625-4100
  • Fax:
Mailing address:
  • Phone: 314-324-3452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberR215974
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: