MEDICARE: MONIQUE ELYSE TINDLE APRN-BC

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	363LA2200X	Adult Health Nurse Practitioner	147230	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174609077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE ELYSE TINDLE APRN-BC

Provider Business Mailing Address
First Line	:	9735 LANDMARK PARKWAY DR
Second Line	:	STE 200
City	:	SAINT LOUIS
State	:	MO
Zip	:	63127-1646
Country	:	US
Telephone Number	:	314-892-6565
Fax Number	:	314-892-4828

Provider Business Practice Location Address
First Line	:	4850 LEMAY FERRY RD
Second Line	:	SUITE 210
City	:	SAINT LOUIS
State	:	MO
Zip	:	63129-1576
Country	:	US
Telephone Number	:	314-892-6565
Fax Number	:	314-892-4828

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	06/24/2016

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