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General NPI Number Information
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NPI Number | 1780986331
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Entity Type | Organization
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Legal Business Name | THE FRUIT OF THE WOMB WOMEN S HEALTH CENTER LLC
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Dates
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Enumeration Date | 12/01/2010
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Last Update Date | 03/05/2011
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Provider Practice Location Address
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Address Line | 637 DUNN RD STE 143
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City | HAZELWOOD
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State | MO
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Zip | 63042-1755
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Country | US
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Telephone | 314-724-4354
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Fax |
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Provider Business Mailing Address
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Address Line | 12519 QUESTOVER CT
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City | CREVE COEUR
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State | MO
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Zip | 63141-6385
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Country | US
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Telephone | 314-724-4354
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Fax |
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Authorized Official
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Title or Position | WOMEN'S HEALTH NURSE PRACTITIONER
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Name | MRS. TANIKA CHERAI MCCLARY
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Credential | APN
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Telephone | 314-724-4354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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