Healthcare Provider Details

I. General information

NPI: 1407535222
Provider Name (Legal Business Name): OUAFAE BOUZIANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MID RIVERS MALL DR
SAINT PETERS MO
63376-1577
US

IV. Provider business mailing address

209 HIDDEN BLUFFS DR
LAKE ST LOUIS MO
63367-6545
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 314-971-5654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023020415
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: