Healthcare Provider Details

I. General information

NPI: 1356731004
Provider Name (Legal Business Name): NATALIE EADS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 JENNINGS STATION RD
SAINT LOUIS MO
63121-3323
US

IV. Provider business mailing address

4000 JENNINGS STATION RD
SAINT LOUIS MO
63121-3323
US

V. Phone/Fax

Practice location:
  • Phone: 314-679-7800
  • Fax:
Mailing address:
  • Phone: 314-679-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014039718
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: