Provider Demographics
NPI:1093161341
Name:SANSONE MERZ, CHRISTINA M (AGPCNP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:M
Last Name:SANSONE MERZ
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:M
Other - Last Name:MERZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16228 PORT OF NANTUCKET DR
Mailing Address - Street 2:
Mailing Address - City:GROVER
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1531
Mailing Address - Country:US
Mailing Address - Phone:314-807-0461
Mailing Address - Fax:
Practice Address - Street 1:915 N GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1621
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH151446363LA2200X, 363LG0600X
MO2016011311363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology