Provider Demographics
NPI:1366096703
Name:DATILLO, CHLOE SUZANNE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:CHLOE
Middle Name:SUZANNE
Last Name:DATILLO
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 NETHERTON DR.
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136
Mailing Address - Country:US
Mailing Address - Phone:314-653-1600
Mailing Address - Fax:314-355-5716
Practice Address - Street 1:2865 NETHERTON DR.
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136
Practice Address - Country:US
Practice Address - Phone:314-653-1600
Practice Address - Fax:314-355-5716
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019025323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily