Provider Demographics
NPI:1437760675
Name:SWEETIN, JUSTIN LUCAS (CNP)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LUCAS
Last Name:SWEETIN
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7727 WESTON PL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-2018
Mailing Address - Country:US
Mailing Address - Phone:314-952-0879
Mailing Address - Fax:
Practice Address - Street 1:232 S WOODS MILL RD STE 110E
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3467
Practice Address - Country:US
Practice Address - Phone:314-542-4998
Practice Address - Fax:314-542-4739
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2020009325363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care