Healthcare Provider Details

I. General information

NPI: 1841231370
Provider Name (Legal Business Name): SIGRID ANDERSON CLINICAL NURSE SPEC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11155 DUNN RD 108N
SAINT LOUIS MO
63136-6150
US

IV. Provider business mailing address

11155 DUNN RD 108N
SAINT LOUIS MO
63136-6150
US

V. Phone/Fax

Practice location:
  • Phone: 314-355-6779
  • Fax: 314-355-4209
Mailing address:
  • Phone: 314-355-6779
  • Fax: 314-355-4209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number2005011227
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: