Healthcare Provider Details

I. General information

NPI: 1265793459
Provider Name (Legal Business Name): SUZANNE WEBB MILLION PA MMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL STE 6A
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

4921 PARKVIEW PL STE 14A
SAINT LOUIS MO
63110-1032
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-2500
  • Fax: 314-747-2521
Mailing address:
  • Phone: 314-454-8778
  • Fax: 314-454-5298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2012009377
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: