Healthcare Provider Details

I. General information

NPI: 1649974247
Provider Name (Legal Business Name): JEANETTE TRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 04/28/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 N NEW BALLAS RD STE 300
SAINT LOUIS MO
63141-6840
US

IV. Provider business mailing address

522 N NEW BALLAS RD STE 300
SAINT LOUIS MO
63141-6840
US

V. Phone/Fax

Practice location:
  • Phone: 314-405-9556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023010979
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: