Provider Demographics
NPI:1033610662
Name:NEUDECKER, MEGAN E (FNP-C)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:E
Last Name:NEUDECKER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 790379
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0379
Mailing Address - Country:US
Mailing Address - Phone:314-729-0077
Mailing Address - Fax:
Practice Address - Street 1:1010 OLD DES PERES RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1865
Practice Address - Country:US
Practice Address - Phone:314-729-0077
Practice Address - Fax:314-729-0101
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018006927363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily