MEDICARE: MRS. ANNETTE PATRICE DINWIDDIE

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1245409515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNETTE PATRICE DINWIDDIE

Provider Business Mailing Address
First Line	:	10608 CROWLEY DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-2427
Country	:	US
Telephone Number	:	314-521-4644
Fax Number	:	314-521-4644

Provider Business Practice Location Address
First Line	:	10608 CROWLEY DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63136-2427
Country	:	US
Telephone Number	:	314-521-4644
Fax Number	:	314-521-4644

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

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	02/20/2008

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