MEDICARE: CINCY REJI

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	F02240786	MO

General Provider Information

NPI Number	:	1538927355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CINCY REJI

Provider Business Mailing Address
First Line	:	109 COUNTRYSHIRE DR
Second Line	:
City	:	LAKE ST LOUIS
State	:	MO
Zip	:	63367-5803
Country	:	US
Telephone Number	:	407-620-5914
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 PARKWOOD LN
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-1334
Country	:	US
Telephone Number	:	314-291-5911
Fax Number	:

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

Provider Enumeration Date	:	03/07/2024
Last Update Date	:	03/07/2024

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Directions to “ CINCY REJI ” Practice Location

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