Healthcare Provider Details

I. General information

NPI: 1396827812
Provider Name (Legal Business Name): SYLVIA L LOMMEL ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 DUNN RD SUITE 304
ST LOUIS MO
63136
US

IV. Provider business mailing address

116 WHITE TREE LN
BALLWIN MO
63011-0802
US

V. Phone/Fax

Practice location:
  • Phone: 314-355-1166
  • Fax: 314-355-9179
Mailing address:
  • Phone: 314-712-2510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number104319
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: