Healthcare Provider Details

I. General information

NPI: 1245755792
Provider Name (Legal Business Name): HEATHER R SCARBOROUGH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2017
Last Update Date: 08/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 RICHMOND CENTER CT
SAINT PETERS MO
63376-5973
US

IV. Provider business mailing address

2 RICHMOND CENTER CT
SAINT PETERS MO
63376-5973
US

V. Phone/Fax

Practice location:
  • Phone: 636-397-2001
  • Fax: 636-279-2010
Mailing address:
  • Phone: 636-397-2001
  • Fax: 636-279-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License Number2005029851
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: