Healthcare Provider Details

I. General information

NPI: 1497485395
Provider Name (Legal Business Name): STL MOBILE HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W PORT PLZ STE 600
SAINT LOUIS MO
63146-3015
US

IV. Provider business mailing address

111 W PORT PLZ STE 600
SAINT LOUIS MO
63146-3015
US

V. Phone/Fax

Practice location:
  • Phone: 618-335-2478
  • Fax:
Mailing address:
  • Phone: 618-335-2478
  • Fax: 636-333-4510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LEANN NITZ
Title or Position: CEO
Credential: NP
Phone: 618-335-2478