Healthcare Provider Details

I. General information

NPI: 1508278730
Provider Name (Legal Business Name): SECIL SCHODROSKI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9717 LANDMARK PARKWAY DR STE 115
SAINT LOUIS MO
63127-1662
US

IV. Provider business mailing address

9717 LANDMARK PARKWAY DR STE 115
SAINT LOUIS MO
63127-1662
US

V. Phone/Fax

Practice location:
  • Phone: 314-722-6555
  • Fax: 314-722-6551
Mailing address:
  • Phone: 636-795-9536
  • Fax: 314-722-6551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2014014296
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number2006032413
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014014296
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: