MEDICARE: STACY D MENEES FNP

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	363LF0000X	Family Nurse Practitioner	209007026	IL

General Provider Information

NPI Number	:	1386815959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY D MENEES FNP

Provider Business Mailing Address
First Line	:	PO BOX 955860
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63195-3988
Country	:	US
Telephone Number	:	636-498-5944
Fax Number	:	618-529-0586

Provider Business Practice Location Address
First Line	:	432 N PLEASANT AVE
Second Line	:
City	:	CENTRALIA
State	:	IL
Zip	:	62801-3006
Country	:	US
Telephone Number	:	618-436-8300
Fax Number	:

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

Provider Enumeration Date	:	03/21/2008
Last Update Date	:	10/20/2020

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