MEDICARE: YOCHEVED JUDY POLTER FNP-BC

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	2017008882	MO

General Provider Information

NPI Number	:	1922668052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOCHEVED JUDY POLTER FNP-BC

Provider Business Mailing Address
First Line	:	8347 DELMAR BLVD APT 1S
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63124-2150
Country	:	US
Telephone Number	:	347-229-5226
Fax Number	:

Provider Business Practice Location Address
First Line	:	6744 CLAYTON RD STE 305
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-1639
Country	:	US
Telephone Number	:	314-274-9232
Fax Number	:

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

Provider Enumeration Date	:	06/20/2019
Last Update Date	:	06/20/2019

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