Provider Demographics
NPI:1508890823
Name:WIJEWEERA, HELEN M (ANP)
Entity Type:Individual
Prefix:MS
First Name:HELEN
Middle Name:M
Last Name:WIJEWEERA
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-362-3500
Mailing Address - Fax:314-230-1119
Practice Address - Street 1:5201 MID AMERICA PLZ
Practice Address - Street 2:DIV IM ENDOCRINOLOGY
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-0002
Practice Address - Country:US
Practice Address - Phone:314-362-3500
Practice Address - Fax:314-230-1119
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO128805363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420002318Medicaid
MO1508890823Medicaid