Healthcare Provider Details

I. General information

NPI: 1285492082
Provider Name (Legal Business Name): MRS. MALYNDA RAMSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 OLIVE ST
SAINT LOUIS MO
63108-3604
US

IV. Provider business mailing address

3615 OLIVE ST
SAINT LOUIS MO
63108-3604
US

V. Phone/Fax

Practice location:
  • Phone: 314-289-6540
  • Fax: 314-289-6301
Mailing address:
  • Phone: 314-289-6540
  • Fax: 314-289-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number2011030068
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: