Provider Demographics
NPI:1114369881
Name:SAWANO, KEIKO (FNP)
Entity Type:Individual
Prefix:MS
First Name:KEIKO
Middle Name:
Last Name:SAWANO
Suffix:
Gender:F
Credentials:FNP
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 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-1408
Mailing Address - Fax:314-747-4342
Practice Address - Street 1:1600 S BRENTWOOD BLVD
Practice Address - Street 2:DIV NEUROLOGY SLEEP MED, STE 600
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63144-1320
Practice Address - Country:US
Practice Address - Phone:314-362-1408
Practice Address - Fax:314-747-4342
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013006956363LF0000X
IL209.013851363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2013006956OtherNP LICENSURE/RECOGNITION