Healthcare Provider Details

I. General information

NPI: 1114279502
Provider Name (Legal Business Name): SANDRA O'NEIL-CALLAHAN WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2012
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4251 FOREST PARK AVENUE
ST. LOUIS MO
63108
US

IV. Provider business mailing address

1573 GLENN BROOKE WOODS CIRCLE
BALLWIN MO
63021
US

V. Phone/Fax

Practice location:
  • Phone: 314-531-7526
  • Fax:
Mailing address:
  • Phone: 314-954-2908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2012033869
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: