Healthcare Provider Details

I. General information

NPI: 1609242619
Provider Name (Legal Business Name): THE HEALTH & WELLNESS CENTER FOR MEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2015
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9717 LANDMARK PARKWAY DR SUITE 115
SAINT LOUIS MO
63127-1628
US

IV. Provider business mailing address

9717 LANDMARK PARKWAY DR SUITE 115
SAINT LOUIS MO
63127-1628
US

V. Phone/Fax

Practice location:
  • Phone: 314-722-6555
  • Fax: 314-722-6551
Mailing address:
  • Phone: 314-722-6555
  • Fax: 314-722-6551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014014296
License Number StateMO

VIII. Authorized Official

Name: MRS. SECIL A SCHODROSKI
Title or Position: OWNER
Credential: FNP
Phone: 314-722-6555