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General NPI Number Information
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NPI Number | 1437409992
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Entity Type | Individual
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Provider Name | MONICA LYNN BOARD RN, FNP
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Gender | Female
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Dates
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Enumeration Date | 09/12/2012
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Last Update Date | 01/23/2020
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Provider Practice Location Address
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Address Line | 3635 VISTA AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63110-2539
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Country | US
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Telephone | 314-577-8790
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Fax |
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Provider Business Mailing Address
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Address Line | 23 FOREST OAK CT
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City | FENTON
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State | MO
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Zip | 63026-3109
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Country | US
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Telephone | 757-254-6550
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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 | 2013045365
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024170365
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2013045365
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License Number State | MO
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