Provider Demographics
NPI:1497485395
Name:STL MOBILE HEALTH CARE
Entity Type:Organization
Organization Name:STL MOBILE HEALTH CARE
Other - Org Name:STL MOBILE HEALTHCARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:NITZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:618-335-2478
Mailing Address - Street 1:111 W PORT PLZ STE 600
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3015
Mailing Address - Country:US
Mailing Address - Phone:618-335-2478
Mailing Address - Fax:636-333-4510
Practice Address - Street 1:111 W PORT PLZ STE 600
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-3015
Practice Address - Country:US
Practice Address - Phone:618-335-2478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty