Provider Demographics
NPI:1184116014
Name:NP HEALTH INFORMATION STATION LLC
Entity type:Organization
Organization Name:NP HEALTH INFORMATION STATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:STOMER
Authorized Official - Suffix:
Authorized Official - Credentials:NURSEPRACTITIONER
Authorized Official - Phone:314-585-1002
Mailing Address - Street 1:3391 N HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-1604
Mailing Address - Country:US
Mailing Address - Phone:314-585-1002
Mailing Address - Fax:314-736-1247
Practice Address - Street 1:3391 N HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-1604
Practice Address - Country:US
Practice Address - Phone:314-585-1002
Practice Address - Fax:314-736-1247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-06
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004029626363LF0000X
MO2011023084363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty