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General NPI Number Information
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NPI Number | 1922567221
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Entity Type | Individual
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Provider Name | FATOU THIAM
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Gender | Female
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Dates
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Enumeration Date | 03/16/2019
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Last Update Date | 03/10/2021
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Provider Practice Location Address
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Address Line | 1551 WALL ST
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City | SAINT CHARLES
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State | MO
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Zip | 63303-3539
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Country | US
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Telephone | 314-814-1477
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Fax |
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Provider Business Mailing Address
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Address Line | 2955 WILLOW CREEK ESTATES DR
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City | FLORISSANT
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State | MO
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Zip | 63031-1665
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Country | US
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Telephone | 314-814-1477
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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 | 2019008966
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License Number State | MO
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