Healthcare Provider Details

I. General information

NPI: 1407384902
Provider Name (Legal Business Name): ALEXIA MARIE MUNTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2017
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 N NEW BALLAS RD STE 129
SAINT LOUIS MO
63141-6812
US

IV. Provider business mailing address

456 N NEW BALLAS RD STE 129
SAINT LOUIS MO
63141-6812
US

V. Phone/Fax

Practice location:
  • Phone: 314-569-1881
  • Fax: 314-569-3277
Mailing address:
  • Phone: 314-569-1881
  • Fax: 314-569-3277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017006575
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: