Healthcare Provider Details

I. General information

NPI: 1346225612
Provider Name (Legal Business Name): IRINA PALATNIK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13380 AMIOT DR
SAINT LOUIS MO
63146-2239
US

IV. Provider business mailing address

13380 AMIOT DR
SAINT LOUIS MO
63146-2239
US

V. Phone/Fax

Practice location:
  • Phone: 314-910-1372
  • Fax: 314-542-0894
Mailing address:
  • Phone: 314-910-1372
  • Fax: 314-542-0894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberMO 146617
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: