MEDICARE: EMILY ANNE FENTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174H00000X	Health Educator

General Provider Information

NPI Number	:	1063924314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY ANNE FENTON

Provider Business Mailing Address
First Line	:	391 MADEWOOD LN
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3229
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	391 MADEWOOD LN
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63017-3229
Country	:	US
Telephone Number	:	636-579-1995
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2017
Last Update Date	:	10/26/2017

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Directions to “ EMILY ANNE FENTON ” Practice Location

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