Provider Demographics
NPI:1033197884
Name:VESEL, JANE CAROL (DNP, CNM)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:CAROL
Last Name:VESEL
Suffix:
Gender:F
Credentials:DNP, CNM
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:CAROL
Other - Last Name:HENDRICKS-VESEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNM
Mailing Address - Street 1:PO BOX 1594
Mailing Address - Street 2:141 S. KINGS RD
Mailing Address - City:LAKE SHERWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63357-8594
Mailing Address - Country:US
Mailing Address - Phone:618-292-6244
Mailing Address - Fax:
Practice Address - Street 1:1000 EDGEWATER PT STE 200
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-2954
Practice Address - Country:US
Practice Address - Phone:636-561-8088
Practice Address - Fax:636-561-1405
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.386924-COA1163W00000X
WI90856-030163W00000X
MO2016012520163W00000X
AZRN109919163WW0101X
IL041-337801163WX0003X
OH14095-NM367A00000X
WI1410-033367A00000X
MO2017008466367A00000X
IL209-004836367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH225892Medicare PIN