Provider Demographics
NPI:1235624479
Name:WEINKAUF, JEANINE MICHELLE (AGNP)
Entity Type:Individual
Prefix:MRS
First Name:JEANINE
Middle Name:MICHELLE
Last Name:WEINKAUF
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 1:5323 ROBERT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-4063
Mailing Address - Country:US
Mailing Address - Phone:314-258-5220
Mailing Address - Fax:
Practice Address - Street 1:14615 MANCHESTER RD STE 103
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63011-3790
Practice Address - Country:US
Practice Address - Phone:314-282-5121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018009356363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology