Provider Demographics
NPI:1164479861
Name:POMMIER, MARY (MSN,RN,CS,GNP,CWS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:POMMIER
Suffix:
Gender:F
Credentials:MSN,RN,CS,GNP,CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:224 S WOODS MILL RD
Mailing Address - Street 2:435-S
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3451
Mailing Address - Country:US
Mailing Address - Phone:314-396-4762
Mailing Address - Fax:314-392-4765
Practice Address - Street 1:224 S WOODS MILL RD
Practice Address - Street 2:435-S
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3451
Practice Address - Country:US
Practice Address - Phone:314-396-4762
Practice Address - Fax:314-392-4765
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO084763363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424780708Medicaid
S93524Medicare UPIN
MO424780708Medicaid