Healthcare Provider Details

I. General information

NPI: 1679744015
Provider Name (Legal Business Name): THERESA M CRUICKSHANK RNC, NNP, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THERESA M SCHROER RNC, NNP, MSN

II. Dates (important events)

Enumeration Date: 03/13/2008
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 KENNERLY RD
SAINT LOUIS MO
63128-2106
US

IV. Provider business mailing address

2933 WESTBOROUGH DR
SAINT CHARLES MO
63301-4546
US

V. Phone/Fax

Practice location:
  • Phone: 314-525-4859
  • Fax:
Mailing address:
  • Phone: 636-947-8647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number066500
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: