Healthcare Provider Details

I. General information

NPI: 1881353381
Provider Name (Legal Business Name): SEJLA MAKSUMIC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2021
Last Update Date: 12/12/2021
Certification Date: 12/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4179 CRESCENT DR STE A
ST. LOUIS MO
63129-1072
US

IV. Provider business mailing address

4179 CRESCENT DR STE A
SAINT LOUIS MO
63129-1072
US

V. Phone/Fax

Practice location:
  • Phone: 314-408-0001
  • Fax: 314-408-0125
Mailing address:
  • Phone: 314-408-0001
  • Fax: 314-408-0125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: