Healthcare Provider Details

I. General information

NPI: 1942532445
Provider Name (Legal Business Name): NICOLE SHUERT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2010
Last Update Date: 01/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 S. NEW BALLAS ROAD SUITE 4017 TOWER B
ST. LOUIS MO
63141
US

IV. Provider business mailing address

621 S. NEW BALLAS ROAD SUITE 4017 TOWER B
ST. LOUIS MO
63141
US

V. Phone/Fax

Practice location:
  • Phone: 314-872-9192
  • Fax:
Mailing address:
  • Phone: 314-872-9192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP007089
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number2015039569
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number0024169798
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: