Healthcare Provider Details

I. General information

NPI: 1316241110
Provider Name (Legal Business Name): NICOLE L CHRISMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 04/17/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 FOREST PARK AVE DIV IM MEDICAL ONCOLOGY, STE 1B
SAINT LOUIS MO
63108-2114
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-1171
  • Fax: 314-362-7086
Mailing address:
  • Phone: 314-747-1171
  • Fax: 314-362-7086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2010022209
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: