Healthcare Provider Details

I. General information

NPI: 1902418221
Provider Name (Legal Business Name): ANDRIA MARIE WEBB CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2020
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3228 IVANHOE AVE
SAINT LOUIS MO
63139-2226
US

IV. Provider business mailing address

3432 HIGHGATE LN
SAINT CHARLES MO
63301-1045
US

V. Phone/Fax

Practice location:
  • Phone: 314-603-0973
  • Fax:
Mailing address:
  • Phone: 314-603-0973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: