Healthcare Provider Details

I. General information

NPI: 1174609077
Provider Name (Legal Business Name): MONIQUE ELYSE TINDLE APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 06/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 LEMAY FERRY RD SUITE 210
SAINT LOUIS MO
63129-1576
US

IV. Provider business mailing address

9735 LANDMARK PARKWAY DR STE 200
SAINT LOUIS MO
63127-1646
US

V. Phone/Fax

Practice location:
  • Phone: 314-892-6565
  • Fax: 314-892-4828
Mailing address:
  • Phone: 314-892-6565
  • Fax: 314-892-4828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number147230
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: