Healthcare Provider Details

I. General information

NPI: 1093849531
Provider Name (Legal Business Name): MARLENE E GUTH ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 01/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S. NEW BALLAS RD SUITE 3017 TOWER B
ST. LOUIS MO
63141
US

IV. Provider business mailing address

621 S. NEW BALLAS RD SUITE 3017 TOWER B
ST. LOUIS MO
63141
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-5814
  • Fax: 314-251-5814
Mailing address:
  • Phone: 314-251-5814
  • Fax: 314-251-5814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number069675
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: