Healthcare Provider Details

I. General information

NPI: 1447500277
Provider Name (Legal Business Name): DORIS L CONN RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S NEW BALLAS RD ONCOLOGY
SAINT LOUIS MO
63141-8221
US

IV. Provider business mailing address

615 S NEW BALLAS RD ONCOLOGY
SAINT LOUIS MO
63141-8221
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6365
  • Fax: 314-251-5698
Mailing address:
  • Phone: 314-251-6365
  • Fax: 314-251-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number062654
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: