Healthcare Provider Details

I. General information

NPI: 1518186428
Provider Name (Legal Business Name): MICHELLE WIKOFF MSN,APRN,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ BARNES JEWISH HOSPITAL
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

1108 SUNSET GREEN DR
O FALLON MO
63366-6316
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-4026
  • Fax:
Mailing address:
  • Phone: 636-379-2259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number145907
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: