Provider Demographics
NPI:1174295323
Name:FENELON, SENADA (AGNP)
Entity Type:Individual
Prefix:MS
First Name:SENADA
Middle Name:
Last Name:FENELON
Suffix:
Gender:F
Credentials:AGNP
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:314-286-2635
Mailing Address - Fax:314-286-2338
Practice Address - Street 1:5201 MID AMERICA PLZ
Practice Address - Street 2:DIV IM RHEUMATOLOGY, STE 2300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-0002
Practice Address - Country:US
Practice Address - Phone:314-286-2635
Practice Address - Fax:314-286-2338
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021006337363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420115964Medicaid