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General NPI Number Information
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NPI Number | 1942491659
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Entity Type | Organization
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Legal Business Name | WINGHAVEN WOMENS CARE INC.
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 08/07/2007
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Provider Practice Location Address
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Address Line | 5551 WINGHAVEN BLVD SUITE 260
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City | O FALLON
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State | MO
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Zip | 63368-3617
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Country | US
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Telephone | 636-928-4884
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Fax | 636-926-3003
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Provider Business Mailing Address
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Address Line | 5551 WINGHAVEN BLVD SUITE 260
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City | O FALLON
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State | MO
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Zip | 63368-3617
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Country | US
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Telephone | 636-928-4884
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Fax | 636-926-3003
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KIRSTEN M MCDANIEL
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Credential | D.O.
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Telephone | 636-928-4884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 2004016557
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License Number State | MO
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