Healthcare Provider Details

I. General information

NPI: 1508305764
Provider Name (Legal Business Name): OLIVIA RHEA ULETT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 04/17/2025
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 N BALLAS RD DEPT EMERGENCY MED
SAINT LOUIS MO
63131-2329
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-966-5000
  • Fax: 314-747-3338
Mailing address:
  • Phone: 314-966-5000
  • Fax: 314-747-3338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2017004688
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: