Healthcare Provider Details

I. General information

NPI: 1508107772
Provider Name (Legal Business Name): SARAH M ROKE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 VISTA AVE
SAINT LOUIS MO
63110-2539
US

IV. Provider business mailing address

5871 RHODES AVE
SAINT LOUIS MO
63109-3414
US

V. Phone/Fax

Practice location:
  • Phone: 314-268-7267
  • Fax:
Mailing address:
  • Phone: 314-457-1681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2013012082
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: