Healthcare Provider Details

I. General information

NPI: 1881246833
Provider Name (Legal Business Name): ROSE M PSARA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSE M GREEN APRN, PMHNP-BC

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11116 S TOWNE SQ
SAINT LOUIS MO
63123-7850
US

IV. Provider business mailing address

11116 S TOWNE SQ
SAINT LOUIS MO
63123-7850
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-1958
  • Fax: 314-567-0037
Mailing address:
  • Phone: 314-567-1958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2019025836
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: