Healthcare Provider Details

I. General information

NPI: 1245292481
Provider Name (Legal Business Name): LAURA A. STODDARD MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6854 PARKER ROAD ST. LOUIS VA, MO VETERAN CBOC CLINIC
SAINT LOUIS MO
63130
US

IV. Provider business mailing address

6854 PARKER ROAD ST. LOUIS CBOC
SAINT LOUIS MO
63130
US

V. Phone/Fax

Practice location:
  • Phone: 314-286-6988
  • Fax: 314-868-2561
Mailing address:
  • Phone: 800-228-5459
  • Fax: 314-868-2561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-005114
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: