Healthcare Provider Details

I. General information

NPI: 1598983223
Provider Name (Legal Business Name): CAROL G. DUANE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROL WEIKEL CPNP

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3691 RUTGER ST SUITE 100
SAINT LOUIS MO
63110-2515
US

IV. Provider business mailing address

3691 RUTGER ST PROVIDER ENROLLMENT
SAINT LOUIS MO
63110-2515
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-6333
  • Fax: 314-977-6340
Mailing address:
  • Phone: 314-977-6828
  • Fax: 314-977-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number078930
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: