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General NPI Number Information
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NPI Number | 1013568518
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Entity Type | Individual
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Provider Name | LINDSEY MARIE ILLINGER A-GNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 232 S WOODS MILL RD STE 400
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City | CHESTERFIELD
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State | MO
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Zip | 63017-3467
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Country | US
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Telephone | 314-205-6744
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Fax |
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Provider Business Mailing Address
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Address Line | 947 BELLESTRI DR
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City | BALLWIN
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State | MO
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Zip | 63021-6483
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Country | US
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Telephone | 314-583-2224
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2019037294
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License Number State | MO
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