Healthcare Provider Details

I. General information

NPI: 1447502034
Provider Name (Legal Business Name): TRACI R DEBEIR RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6643 SHEPLEY DR
SAINT LOUIS MO
63105-2354
US

IV. Provider business mailing address

6643 SHEPLEY DRIVE
ST LOUIS MO
63130
US

V. Phone/Fax

Practice location:
  • Phone: 314-935-6666
  • Fax:
Mailing address:
  • Phone: 314-935-6666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number2007010047
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: