Provider Demographics
NPI:1306401559
Name:HELLWEG, NICOLE D (PA-C, MPAS)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:D
Last Name:HELLWEG
Suffix:
Gender:F
Credentials:PA-C, MPAS
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:D
Other - Last Name:URSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MPAS
Mailing Address - Street 1:8225 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1107
Mailing Address - Country:US
Mailing Address - Phone:314-330-4776
Mailing Address - Fax:
Practice Address - Street 1:8225 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1107
Practice Address - Country:US
Practice Address - Phone:314-330-4776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-02
Last Update Date:2022-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9112173363A00000X
MO2020025034208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty