Healthcare Provider Details

I. General information

NPI: 1336157023
Provider Name (Legal Business Name): JEANE LOUISE STOHLDRIER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 04/17/2025
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 N NEW BALLAS RD DIV SURG VASCULAR, STE 265
SAINT LOUIS MO
63141-6825
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-4644
  • Fax: 866-342-0133
Mailing address:
  • Phone: 314-991-4644
  • Fax: 866-342-0133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2006020249
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: