Healthcare Provider Details

I. General information

NPI: 1992055099
Provider Name (Legal Business Name): DOMUS MEDICAL HOUSE CALLS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2012
Last Update Date: 09/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13380 AMIOT DR
SAINT LOUIS MO
63146-2239
US

IV. Provider business mailing address

13380 AMIOT DR
SAINT LOUIS MO
63146-2239
US

V. Phone/Fax

Practice location:
  • Phone: 314-910-1372
  • Fax: 314-542-0894
Mailing address:
  • Phone: 314-910-1372
  • Fax: 314-542-0894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: IRINA PALATNIK
Title or Position: OWNER
Credential: ANP
Phone: 314-910-1372