Healthcare Provider Details

I. General information

NPI: 1992021828
Provider Name (Legal Business Name): CHRISTINE FLEAGLE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2010
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8888 LADUE RD SUITE 130
SAINT LOUIS MO
63124-2056
US

IV. Provider business mailing address

8888 LADUE RD SUITE 130
SAINT LOUIS MO
63124-2056
US

V. Phone/Fax

Practice location:
  • Phone: 314-862-4002
  • Fax:
Mailing address:
  • Phone: 314-862-4002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number039448
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: