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General NPI Number Information
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NPI Number | 1588989453
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Entity Type | Individual
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Provider Name | ANGELA RAE SQROW WHNP
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Gender | Female
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Dates
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Enumeration Date | 04/02/2010
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Last Update Date | 06/28/2022
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Provider Practice Location Address
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Address Line | 1011 BOWLES AVE STE G10
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City | FENTON
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State | MO
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Zip | 63026-2387
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Country | US
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Telephone | 636-496-5453
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 955534
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City | SAINT LOUIS
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State | MO
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Zip | 63195-5534
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Country | US
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Telephone |
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 156027
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License Number State | MO
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