Provider Demographics
NPI:1740421262
Name:SEVERINE, JANET EVE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:EVE
Last Name:SEVERINE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5828 BRIDLEFORD LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-2201
Mailing Address - Country:US
Mailing Address - Phone:314-487-4905
Mailing Address - Fax:
Practice Address - Street 1:5828 BRIDLEFORD LN
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-2201
Practice Address - Country:US
Practice Address - Phone:314-487-4905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOA1108151363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health