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General NPI Number Information
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NPI Number | 1376233825
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Entity Type | Individual
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Provider Name | SHANITA GATES
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Gender | Female
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Dates
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Enumeration Date | 05/09/2023
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Last Update Date | 05/09/2023
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Provider Practice Location Address
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Address Line | 3668 S GEYER RD
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City | SAINT LOUIS
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State | MO
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Zip | 63127-1249
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Country | US
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Telephone | 314-821-8022
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Fax |
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Provider Business Mailing Address
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Address Line | 1321 N 8TH ST
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City | SAINT LOUIS
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State | MO
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Zip | 63106-4514
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Country | US
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Telephone | 314-788-1437
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 20I5055
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License Number State | MO
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