Provider Demographics
NPI:1396827812
Name:LOMMEL, SYLVIA L (ANP)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:L
Last Name:LOMMEL
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 WHITE TREE LN
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-0802
Mailing Address - Country:US
Mailing Address - Phone:314-712-2510
Mailing Address - Fax:
Practice Address - Street 1:11125 DUNN RD
Practice Address - Street 2:SUITE 304
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136
Practice Address - Country:US
Practice Address - Phone:314-355-1166
Practice Address - Fax:314-355-9179
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO104319363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOQ37863Medicare UPIN
MO824301798Medicare ID - Type Unspecified