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General NPI Number Information
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NPI Number | 1538699244
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Entity Type | Individual
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Provider Name | JEFFREY TERRY VACEK DNP
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Gender | Male
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Dates
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Enumeration Date | 06/14/2017
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 725 S 5TH ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2913
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Country | US
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Telephone | 636-922-9182
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Fax |
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Provider Business Mailing Address
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Address Line | 3924 SUMMER FOREST DR
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City | SAINT CHARLES
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State | MO
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Zip | 63304-2642
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Country | US
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Telephone | 636-288-3458
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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 | 2017019598
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License Number State | MO
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