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General NPI Number Information
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NPI Number | 1871509505
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF VETERANS AFFAIRS
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 915 N GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63106-1621
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Country | US
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Telephone | 314-289-6343
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Fax | 314-289-6442
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Provider Business Mailing Address
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Address Line | 46 SMALLING CT
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City | BELLEVILLE
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State | IL
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Zip | 62223-2124
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Country | US
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Telephone | 618-397-9211
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Fax |
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Authorized Official
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Title or Position | ANP/CLINICAL COORDINATOR
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Name | KATHLEEN ANN WENZEL
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Credential | RN,ANP
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Telephone | 314-289-6343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 363LA2200X
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License Number State | MO
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