Healthcare Provider Details

I. General information

NPI: 1760754600
Provider Name (Legal Business Name): LAURA KRUMMEL CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LAURA LANGE

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S NEW BALLAS RD
SAINT LOUIS MO
63141-8232
US

IV. Provider business mailing address

621 S NEW BALLAS RD
SAINT LOUIS MO
63141-8232
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2007021389
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2011027261
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: