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General NPI Number Information
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NPI Number | 1124620893
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Entity Type | Individual
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Provider Name | MAUREEN A POPLAR
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Gender | Female
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 03/01/2021
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Provider Practice Location Address
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Address Line | 11125 DUNN RD STE 204
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City | SAINT LOUIS
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State | MO
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Zip | 63136-6188
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Country | US
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Telephone | 314-839-5125
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Fax | 314-839-5351
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Provider Business Mailing Address
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Address Line | PO BOX 503643
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City | SAINT LOUIS
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State | MO
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Zip | 63150-3643
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Country | US
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Telephone | 314-839-5125
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Fax | 314-839-5351
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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 | 2020041026
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 226456-30
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License Number State | WI
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