Healthcare Provider Details

I. General information

NPI: 1265652432
Provider Name (Legal Business Name): TONYA SUE SHEARER RNC, NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONYA SUE MCCOY

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 11/12/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

207 WILLARD DR
O FALLON IL
62269-2241
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5631
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number154005
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: