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NPI Code Detail

MEDICARE: MRS. MICHELE NEUDECKER

MEDICARE: MRS. MICHELE NEUDECKER
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
1363LA2200XAdult Health Nurse Practitioner076292MO

General Provider Information

NPI Number : 1851381206
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELE NEUDECKER
Provider Business Mailing Address
First Line : 6651 CHIPPEWA ST STE 322
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63109-2532
Country : US
Telephone Number : 314-457-9338
Fax Number : 314-457-9341
Provider Business Practice Location Address
First Line : 2325 DOUGHERTY FERRY RD STE 104
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63122-3356
Country : US
Telephone Number : 148-216-8893
Fax Number : 314-457-9341
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2005
Last Update Date : 08/28/2020

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Directions to “ MRS. MICHELE NEUDECKER ” Practice Location

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