Provider Demographics
NPI:1104215086
Name:JADWISIAK, LOUISE (RN,CPNP)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:JADWISIAK
Suffix:
Gender:F
Credentials:RN,CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 GOODWIN DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4122
Mailing Address - Country:US
Mailing Address - Phone:636-933-4141
Mailing Address - Fax:636-931-7007
Practice Address - Street 1:35 GOODWIN DR
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4122
Practice Address - Country:US
Practice Address - Phone:636-933-4141
Practice Address - Fax:636-931-7007
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012011747363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics