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General NPI Number Information
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NPI Number | 1184175085
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Entity Type | Individual
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Provider Name | MISRAK GEBISSA
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Gender | Female
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 9 SACKSTON WOODS LN
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City | CREVE COEUR
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State | MO
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Zip | 63141-8228
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Country | US
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Telephone | 877-748-7030
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Fax |
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Provider Business Mailing Address
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Address Line | 10315 TUXFORD DR APT 10
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City | SAINT LOUIS
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State | MO
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Zip | 63146-5825
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Country | US
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Telephone | 314-749-3615
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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 | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | AG0416096
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License Number State | MO
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