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General NPI Number Information
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NPI Number | 1508372608
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Entity Type | Individual
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Provider Name | MACAELA DAWN VERETT AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/27/2017
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 10010 KENNERLY RD
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2106
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Country | US
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Telephone | 314-525-1906
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Fax |
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Provider Business Mailing Address
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Address Line | 9620 CHAMBLIN DR
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City | SAINT LOUIS
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State | MO
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Zip | 63123-6208
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Country | US
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Telephone | 314-371-8192
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2021030137
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License Number State | MO
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