Provider Demographics
NPI:1811739170
Name:ALDERSON, JANE M (MSN, RN, LMT)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:M
Last Name:ALDERSON
Suffix:
Gender:F
Credentials:MSN, RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-1427
Mailing Address - Country:US
Mailing Address - Phone:815-546-6258
Mailing Address - Fax:
Practice Address - Street 1:2811 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-1427
Practice Address - Country:US
Practice Address - Phone:815-546-6258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-08
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022009960163W00000X
IL041207215163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041207215OtherSTATE OF ILLINOIS DEPT OF FINANCIAL AND PROFESSIONAL REGULATION
45035292OtherNSNCB
MO2022009960OtherSTATE OF MISSOURI DIVISION OF PROFESSIONAL REGISTRATION