Provider Demographics
NPI:1801824610
Name:EAGON, JANE MARIE (RN BC ANP)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:MARIE
Last Name:EAGON
Suffix:
Gender:F
Credentials:RN BC ANP
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:MARIE
Other - Last Name:CZERNIEJEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:670 MASON RIDGE CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8573
Mailing Address - Country:US
Mailing Address - Phone:314-996-7800
Mailing Address - Fax:314-996-7829
Practice Address - Street 1:3009 N BALLAS RD
Practice Address - Street 2:STE 227A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2322
Practice Address - Country:US
Practice Address - Phone:314-996-7800
Practice Address - Fax:314-996-7829
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO091049363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P13138Medicare UPIN