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NPI Code Detail

MEDICARE: DONNA BAUDENDISTEL

MEDICARE: DONNA BAUDENDISTEL
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
1363L00000XNurse Practitioner069563MO

General Provider Information

NPI Number : 1417904624
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA BAUDENDISTEL
Provider Business Mailing Address
First Line : 161 WASHINGTON ST
Second Line : 14TH FLOOR, SUITE 1400
City : CONSHOHOCKEN
State : PA
Zip : 19428-2083
Country : US
Telephone Number : 866-825-3227
Fax Number :
Provider Business Practice Location Address
First Line : 6071 TELEGRAPH RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63129-4758
Country : US
Telephone Number : 314-846-9265
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2006
Last Update Date : 07/08/2007

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Directions to “ DONNA BAUDENDISTEL ” Practice Location

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