Healthcare Provider Details

I. General information

NPI: 1033424676
Provider Name (Legal Business Name): MEGHAN BLUM LINDEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 S BRENTWOOD BLVD SUITE 1120
SAINT LOUIS MO
63117-1223
US

IV. Provider business mailing address

4 OLSNEY CT
SAINT CHARLES MO
63303-3194
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-4600
  • Fax:
Mailing address:
  • Phone: 314-977-4600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2010-0038
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: