Provider Demographics
NPI:1760667877
Name:MCGINNIS, JOAN M (RN,MSN,CDE)
Entity type:Individual
Prefix:MR
First Name:JOAN
Middle Name:M
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:RN,MSN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-1861
Mailing Address - Country:US
Mailing Address - Phone:314-962-2833
Mailing Address - Fax:
Practice Address - Street 1:444 S BRENTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-2521
Practice Address - Country:US
Practice Address - Phone:314-725-1888
Practice Address - Fax:314-725-1444
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO053438163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator