Healthcare Provider Details

I. General information

NPI: 1740997527
Provider Name (Legal Business Name): ASHLEY DANIELLE NATOR FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 11/15/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL DIV NEURO SURG, STE 6B/6C
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

660 S EUCLID AVE CB 8057
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-3577
  • Fax: 314-362-2107
Mailing address:
  • Phone: 314-362-3577
  • Fax: 314-362-2107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022043896
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: