Healthcare Provider Details

I. General information

NPI: 1528214939
Provider Name (Legal Business Name): MICHELLE L DEGUIRE ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL 5TH FLOOR SUITE C
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8126
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-7603
  • Fax: 314-747-5213
Mailing address:
  • Phone: 314-362-7603
  • Fax: 314-747-5213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number148391
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: