=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447782065
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRICIA L. REEB FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2017
-----------------------------------------------------
Last Update Date | 04/02/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 85 SORREL LN
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63124-1106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-882-3239
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 85 SORREL LN
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63124-1106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-882-3239
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 126776
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------