Healthcare Provider Details

I. General information

NPI: 1568714335
Provider Name (Legal Business Name): PARISA KAHROMI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 10/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6651 CHIPPEWA ST SUITE 224
SAINT LOUIS MO
63109-2538
US

IV. Provider business mailing address

6651 CHIPPEWA ST SUITE 224
SAINT LOUIS MO
63109-2538
US

V. Phone/Fax

Practice location:
  • Phone: 314-645-6840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number2012035485
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: