Healthcare Provider Details

I. General information

NPI: 1871292672
Provider Name (Legal Business Name): JAMES NANTELL RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 N BALLAS RD
SAINT LOUIS MO
63131-2329
US

IV. Provider business mailing address

604 VILLAGE DR
GLEN CARBON IL
62034-2732
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-6500
  • Fax:
Mailing address:
  • Phone: 618-580-1686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number102201
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: