Most Relevant Information
Provider Data
| NPI Number: | 1003362021 |
| Provider Name: | STEPHANIE NELLESEN FNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 2016022548 |
Most Important Dates
| Enumeration Date: | 08/30/2016 |
| Last Updated: | 11/16/2018 |
Provider Practice Location
621 S NEW BALLAS RD STE 189A
SAINT LOUIS
MO
631418255
Practice Location Phone/Fax
| Phone: | 3142516335 |
| Fax: | 3142515864 |
Provider Mailing Location
621 S NEW BALLAS RD STE 189A
SAINT LOUIS
MO
631418255
Provider Mailing Phone/Fax
| Phone: | 3142516335 |
| Fax: | 3142515864 |