Healthcare Provider Details

I. General information

NPI: 1306065800
Provider Name (Legal Business Name): ELAINE M DETERS-DUNN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13131 TESSON FERRY RD SUITE 129
SAINT LOUIS MO
63128-3887
US

IV. Provider business mailing address

43 QUAIL WOODS DR
FENTON MO
63026-3444
US

V. Phone/Fax

Practice location:
  • Phone: 314-842-4920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number071513
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: