Provider Demographics
NPI:1205106291
Name:GAGE, ALLISON (NP-C)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:GAGE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:TRENTMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12200 WEBER HILL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1599
Mailing Address - Country:US
Mailing Address - Phone:314-698-2500
Mailing Address - Fax:
Practice Address - Street 1:12200 WEBER HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1599
Practice Address - Country:US
Practice Address - Phone:314-698-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOA1211046363LA2200X
MO2012001657363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1205106291Medicaid