Healthcare Provider Details

I. General information

NPI: 1700827755
Provider Name (Legal Business Name): MAYOLA ROWSER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5669 DELMAR BLVD
SAINT LOUIS MO
63112-2615
US

IV. Provider business mailing address

415 MULBERRY STREET
EVANSVILLE IN
47113-1230
US

V. Phone/Fax

Practice location:
  • Phone: 314-531-1770
  • Fax: 314-241-1185
Mailing address:
  • Phone: 812-423-7791
  • Fax: 812-422-7558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2025006273
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: