Provider Demographics
NPI:1851874234
Name:ST LOUIS, JEAN
Entity Type:Individual
Prefix:MR
First Name:JEAN
Middle Name:
Last Name:ST LOUIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13605 NE 3RD CT APT 420
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-3604
Mailing Address - Country:US
Mailing Address - Phone:305-962-1798
Mailing Address - Fax:
Practice Address - Street 1:13605 NE 3RD CT APT 420
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-3604
Practice Address - Country:US
Practice Address - Phone:305-962-1798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5191022164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse