Healthcare Provider Details

I. General information

NPI: 1447037486
Provider Name (Legal Business Name): INDEPENDENT NURSE COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 1ST CAPITOL DR STE 203&204
SAINT CHARLES MO
63301-2734
US

IV. Provider business mailing address

3541 TARN ST
SAINT CHARLES MO
63301-8366
US

V. Phone/Fax

Practice location:
  • Phone: 636-385-4559
  • Fax: 314-754-9560
Mailing address:
  • Phone: 636-385-4559
  • Fax: 314-754-9560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: NICOLE DORAN
Title or Position: OWNER/CEO
Credential: RN
Phone: 636-385-4559