Healthcare Provider Details

I. General information

NPI: 1578629945
Provider Name (Legal Business Name): ROSA M. PROUHET CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS ROSA M. PALOMO

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JEFFERSON BARRACKS DR BLDG 55
SAINT LOUIS MO
63125-4181
US

IV. Provider business mailing address

1 JEFFERSON BARRACKS DR BLDG 55
SAINT LOUIS MO
63125-4181
US

V. Phone/Fax

Practice location:
  • Phone: 314-652-4100
  • Fax: 314-894-6614
Mailing address:
  • Phone: 314-652-4100
  • Fax: 314-894-6614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number075775-23
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number075775-21
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041275771
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number124452
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209006099
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number124452
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: