Provider Demographics
NPI:1922424647
Name:BOUNDS, MAGGIE M
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:M
Last Name:BOUNDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 EDMUND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-5613
Mailing Address - Country:US
Mailing Address - Phone:314-449-6010
Mailing Address - Fax:314-932-5436
Practice Address - Street 1:2115 EDMUND AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-5613
Practice Address - Country:US
Practice Address - Phone:314-449-6010
Practice Address - Fax:314-932-5436
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO3747P1801X3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant