Provider Demographics
NPI:1073150017
Name:WADSWORTH, ZOE MARIE (APRN-CPNP)
Entity Type:Individual
Prefix:MRS
First Name:ZOE
Middle Name:MARIE
Last Name:WADSWORTH
Suffix:
Gender:F
Credentials:APRN-CPNP
Other - Prefix:MS
Other - First Name:ZOE
Other - Middle Name:MARIE
Other - Last Name:PREIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CPNP
Mailing Address - Street 1:1309 PINETREE LANE
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119
Mailing Address - Country:US
Mailing Address - Phone:314-402-0129
Mailing Address - Fax:
Practice Address - Street 1:12255 DEPAUL DR SUITE 300
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044
Practice Address - Country:US
Practice Address - Phone:314-344-6021
Practice Address - Fax:314-344-6131
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019011504363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics