Healthcare Provider Details

I. General information

NPI: 1508317157
Provider Name (Legal Business Name): TRISTEN LEE DONNER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/11/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 MARYVILLE UNIVERSITY DR
SAINT LOUIS MO
63141-5849
US

IV. Provider business mailing address

650 MARYVILLE UNIVERSITY DR
SAINT LOUIS MO
63141-5849
US

V. Phone/Fax

Practice location:
  • Phone: 314-529-9300
  • Fax:
Mailing address:
  • Phone: 314-529-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023038573
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2023038573
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: