Healthcare Provider Details

I. General information

NPI: 1154564755
Provider Name (Legal Business Name): VERONICA FISCHER MCDONNELL RD LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VERONICA JOY FISCHER RD LD

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12855 N 40 DR SUITE 205
SAINT LOUIS MO
63141-8657
US

IV. Provider business mailing address

12855 N 40 DR
SAINT LOUIS MO
63141-8657
US

V. Phone/Fax

Practice location:
  • Phone: 314-720-0900
  • Fax:
Mailing address:
  • Phone: 314-720-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2000170598
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number2000170598
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: