Healthcare Provider Details

I. General information

NPI: 1841584802
Provider Name (Legal Business Name): TOSANNUA NEWMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 JENNINGS STATION RD
SAINT LOUIS MO
63121-3323
US

IV. Provider business mailing address

111 S MERAMEC AVE 41 S CENTRAL
CLAYTON MO
63105-1711
US

V. Phone/Fax

Practice location:
  • Phone: 314-679-7880
  • Fax: 314-679-7846
Mailing address:
  • Phone: 314-615-0600
  • Fax: 314-615-8303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2008006438
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: