Healthcare Provider Details

I. General information

NPI: 1689797128
Provider Name (Legal Business Name): MICHELLE LOUISE NADLER APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL SUITE 11 W 45
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

1 CHILDRENS PL SUITE 11 W 45
SAINT LOUIS MO
63110-1002
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6254
  • Fax: 314-454-2762
Mailing address:
  • Phone: 314-454-6254
  • Fax: 314-454-2762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number106643
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: