Healthcare Provider Details

I. General information

NPI: 1730760737
Provider Name (Legal Business Name): JULIE ANN HAKE WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 04/17/2025
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 FOREST PARK AVE DIV OBGYN PELVIC MED/RECONSTRUCT SURG, STE 710
SAINT LOUIS MO
63108-1495
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-747-1402
  • Fax: 314-362-3328
Mailing address:
  • Phone: 314-747-1402
  • Fax: 314-362-3328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2021011079
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: