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NPI Code Detail

MEDICARE: MS. MARCELLA M PETZCHEN NP

MEDICARE: MS. MARCELLA M PETZCHEN NP
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
1163W00000XRegistered Nurse051062MO
2363LP2300XPrimary Care Nurse Practitioner051062MO
3363LW0102XWomen's Health Nurse Practitioner051062MO
4363LA2200XAdult Health Nurse Practitioner051062MO

General Provider Information

NPI Number : 1255393716
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARCELLA M PETZCHEN NP
Provider Business Mailing Address
First Line : 3691 RUTGER AVE
Second Line : PROVIDER ENROLLMENT
City : ST LOUIS
State : MO
Zip : 63110
Country : US
Telephone Number : 314-977-4440
Fax Number :
Provider Business Practice Location Address
First Line : 3660 VISTA AVE
Second Line : SUITE 207
City : SAINT LOUIS
State : MO
Zip : 63110-2540
Country : US
Telephone Number : 314-977-6100
Fax Number : 314-977-6137
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2006
Last Update Date : 08/04/2025

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