Healthcare Provider Details

I. General information

NPI: 1841715554
Provider Name (Legal Business Name): NATALIE LOUISE GOEDEKER PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 04/17/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 PARKVIEW PL DIV NEUROLOGY NEUROMUSCULAR, 7TH FL
SAINT LOUIS MO
63110-1032
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-6981
  • Fax: 314-362-3752
Mailing address:
  • Phone: 314-362-6981
  • Fax: 314-362-3752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2017009933
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: