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General NPI Number Information
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NPI Number | 1356449144
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Entity Type | Individual
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Provider Name | IMMACULA SAINT-LOUIS MD
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Gender | Female
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 303 GREEN ST E
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City | WILSON
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State | NC
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Zip | 27893-4105
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Country | US
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Telephone | 252-243-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 303 GREEN ST E
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City | WILSON
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State | NC
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Zip | 27893-4105
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Country | US
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Telephone | 252-243-9800
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Fax | 252-243-9888
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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 | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 2005-01289
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 151877
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D0088037
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2005-01289
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License Number State | NC
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