Provider Demographics
NPI:1215218136
Name:WUELLNER, MARY BETH (NP)
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:WUELLNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARY BETH
Other - Middle Name:
Other - Last Name:TURVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4251 FOREST PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2810
Mailing Address - Country:US
Mailing Address - Phone:314-531-7526
Mailing Address - Fax:314-531-9731
Practice Address - Street 1:2796 N HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-1402
Practice Address - Country:US
Practice Address - Phone:314-921-4445
Practice Address - Fax:314-921-5165
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO209005737363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner