Healthcare Provider Details

I. General information

NPI: 1710510714
Provider Name (Legal Business Name): ROMNEY NICOLE RICE-DUNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 OLIVE ST
SAINT LOUIS MO
63103-2360
US

IV. Provider business mailing address

715 HARMONY RIDGE DR
SAINT PETERS MO
63376-2582
US

V. Phone/Fax

Practice location:
  • Phone: 314-651-0921
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number2001006647
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: