Healthcare Provider Details

I. General information

NPI: 1992764195
Provider Name (Legal Business Name): MARY ELLEN MYERS RN, APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY ELLEN AUBUCHON RN, APRN-C

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 S JEFFERSON AVE
SAINT LOUIS MO
63118-3930
US

IV. Provider business mailing address

1694 VALERO LN
FENTON MO
63026-3259
US

V. Phone/Fax

Practice location:
  • Phone: 314-776-7999
  • Fax: 844-848-6137
Mailing address:
  • Phone: 314-540-0623
  • Fax: 844-848-6137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN077928
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: