Healthcare Provider Details

I. General information

NPI: 1750907077
Provider Name (Legal Business Name): GRACE B PELOWSKI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MARYLAND PLZ
SAINT LOUIS MO
63108-1556
US

IV. Provider business mailing address

30 MARYLAND PLZ
SAINT LOUIS MO
63108-1556
US

V. Phone/Fax

Practice location:
  • Phone: 314-720-1644
  • Fax:
Mailing address:
  • Phone: 314-720-1644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11006037
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number433478
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number15249
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: