Healthcare Provider Details

I. General information

NPI: 1497432546
Provider Name (Legal Business Name): LINA OKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

2200 LASALLE ST
SAINT LOUIS MO
63104-2764
US

V. Phone/Fax

Practice location:
  • Phone: 314-257-8000
  • Fax:
Mailing address:
  • Phone: 314-261-6970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2023018340
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: