MEDICARE: MRS. JEANINE MICHELLE WEINKAUF AGNP

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	363LG0600X	Gerontology Nurse Practitioner	2018009356	MO
2	363LA2200X	Adult Health Nurse Practitioner	2018009356	MO

General Provider Information

NPI Number	:	1235624479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JEANINE MICHELLE WEINKAUF AGNP

Provider Business Mailing Address
First Line	:	5323 ROBERT AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-4063
Country	:	US
Telephone Number	:	314-258-5220
Fax Number	:

Provider Business Practice Location Address
First Line	:	12977 N 40 DR STE 309
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8654
Country	:	US
Telephone Number	:	314-301-9107
Fax Number	:	314-207-0261

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

Provider Enumeration Date	:	06/29/2018
Last Update Date	:	11/19/2024

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