Healthcare Provider Details

I. General information

NPI: 1134147648
Provider Name (Legal Business Name): KATHLEEN P LOBELLO ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 N MASON RD
SAINT LOUIS MO
63141-6399
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8242
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-8200
  • Fax: 314-576-8880
Mailing address:
  • Phone: 314-362-8200
  • Fax: 314-576-8880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number065304
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: