Healthcare Provider Details

I. General information

NPI: 1154789048
Provider Name (Legal Business Name): LOUISE BLASE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD STE 227A
SAINT LOUIS MO
63131-2308
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-2329
US

V. Phone/Fax

Practice location:
  • Phone: 314-448-3791
  • Fax:
Mailing address:
  • Phone: 314-996-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2015040102
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2015040102
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: