Provider Demographics
NPI:1932160637
Name:MARCUS, MICHELE C (NP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:C
Last Name:MARCUS
Suffix:
Gender:F
Credentials:NP
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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:314-525-0490
Mailing Address - Fax:314-525-0434
Practice Address - Street 1:3844 S LINDBERGH BLVD
Practice Address - Street 2:STE 120
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1368
Practice Address - Country:US
Practice Address - Phone:314-525-0490
Practice Address - Fax:314-525-0434
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2017-04-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO104267363LG0600X
MO2011001347363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO429078108Medicaid
MO823340556Medicare ID - Type Unspecified
MOQ33840Medicare UPIN