Healthcare Provider Details

I. General information

NPI: 1053074997
Provider Name (Legal Business Name): FAYE MONAHAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 02/14/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S GRAND BLVD
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

SAINT LOUIS UNIVERSITY HOSPITAL 1201 SOUTH GRAND
SAINT LOUIS MO
63104-2547
US

V. Phone/Fax

Practice location:
  • Phone: 314-257-8000
  • Fax:
Mailing address:
  • Phone: 314-257-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2021041601
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: