Healthcare Provider Details

I. General information

NPI: 1144531401
Provider Name (Legal Business Name): TONI LOUISE WOZNIAK W.H.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 KENNERLY RD PHYSICIANS BLDG A- STE 350
SAINT LOUIS MO
63128-2141
US

IV. Provider business mailing address

10004 KENNERLY RD PHYSICIANS BLDG A- STE 350
SAINT LOUIS MO
63128-2141
US

V. Phone/Fax

Practice location:
  • Phone: 314-543-5980
  • Fax: 314-543-5979
Mailing address:
  • Phone: 314-543-5980
  • Fax: 314-543-5979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2003015712
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: