Healthcare Provider Details

I. General information

NPI: 1497837959
Provider Name (Legal Business Name): DELLA LOUISE ARIDGE RN, MSN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 01/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 KENNERLY RD SUITE 330 A
SAINT LOUIS MO
63128-2141
US

IV. Provider business mailing address

10004 KENNERLY RD SUITE 330A
SAINT LOUIS MO
63128-2141
US

V. Phone/Fax

Practice location:
  • Phone: 314-543-5963
  • Fax: 314-525-4323
Mailing address:
  • Phone: 314-543-5963
  • Fax: 314-525-4323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number063677
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number063677
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: