Healthcare Provider Details

I. General information

NPI: 1427033679
Provider Name (Legal Business Name): MARY ANN SWEENEY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4352 MANCHESTER AVE
SAINT LOUIS MO
63110-2138
US

IV. Provider business mailing address

9415 WORKBENCH DR
SAINT LOUIS MO
63127-1648
US

V. Phone/Fax

Practice location:
  • Phone: 314-531-5444
  • Fax: 314-531-0063
Mailing address:
  • Phone: 314-775-9042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number126492
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: