Healthcare Provider Details

I. General information

NPI: 1699896019
Provider Name (Legal Business Name): LAURA L OCHOA ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 04/25/2024
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 09/07/2010

III. Provider practice location address

4921 PARKVIEW PL DEPT RADIATION ONCOLOGY, LL
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

PO BOX 60352
SAINT LOUIS MO
63160-0352
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-7236
  • Fax: 314-747-9557
Mailing address:
  • Phone: 314-747-7236
  • Fax: 314-747-9557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number091104
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: