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General NPI Number Information
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NPI Number | 1457686503
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Entity Type | Individual
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Provider Name | DANA NOELLE DEMARTINI LMT
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Gender | Female
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Dates
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Enumeration Date | 10/07/2009
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Last Update Date | 10/07/2009
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Provider Practice Location Address
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Address Line | 266 LAMP & LANTERN
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City | TOWN & COUNTRY
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State | MO
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Zip | 63017
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Country | US
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Telephone | 636-227-4949
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Fax |
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Provider Business Mailing Address
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Address Line | 230 VEST AVE
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City | VALLEY PARK
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State | MO
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Zip | 63088-1730
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Country | US
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Telephone | 636-825-3384
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 2001030121
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License Number State | MO
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