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General NPI Number Information
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NPI Number | 1558423251
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Entity Type | Individual
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Provider Name | PATRICIA A JENTSCH FNP
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Gender | Female
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Dates
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Enumeration Date | 12/16/2006
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Last Update Date | 05/25/2010
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Provider Practice Location Address
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Address Line | 12700 SOUTHFORK RD SUITE 220
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City | SAINT LOUIS
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State | MO
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Zip | 63128-3201
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Country | US
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Telephone | 314-525-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 1784 PRESTON CENTRE DR
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City | FENTON
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State | MO
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Zip | 63026-6610
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Country | US
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Telephone | 636-861-3321
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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 | 78333
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License Number State | MO
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