Healthcare Provider Details

I. General information

NPI: 1205106291
Provider Name (Legal Business Name): ALLISON GAGE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON TRENTMANN

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 03/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12200 WEBER HILL RD STE 100
SAINT LOUIS MO
63127-1599
US

IV. Provider business mailing address

12200 WEBER HILL RD STE 100
SAINT LOUIS MO
63127-1599
US

V. Phone/Fax

Practice location:
  • Phone: 314-698-2500
  • Fax:
Mailing address:
  • Phone: 314-698-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberA1211046
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number2012001657
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: