1750338174 NPI number — MRS. PATRICIA M SOHN MSN, APRN-BC, ANP

Table of content: MRS. PATRICIA M SOHN MSN, APRN-BC, ANP (NPI 1750338174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750338174 NPI number — MRS. PATRICIA M SOHN MSN, APRN-BC, ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOHN
Provider First Name:
PATRICIA
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, APRN-BC, ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RUZICKA
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN, APRN-BC, ANP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750338174
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12639 OLD TESSON RD
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63128-2786
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-849-0311
Provider Business Mailing Address Fax Number:
314-849-4423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1390 HIGHWAY 61 # B
Provider Second Line Business Practice Location Address:
G-1000
Provider Business Practice Location Address City Name:
FESTUS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63028-4137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-933-7400
Provider Business Practice Location Address Fax Number:
636-933-7403
Provider Enumeration Date:
05/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  064101 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500025716 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 427295100 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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