Provider Demographics
NPI:1104101872
Name:PROWELL, TANIKA JOI (RN)
Entity type:Individual
Prefix:MISS
First Name:TANIKA
Middle Name:JOI
Last Name:PROWELL
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:111 S MERAMEC AVE
Mailing Address - Street 2:41 S CENTRAL AVE
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1711
Mailing Address - Country:US
Mailing Address - Phone:314-615-0600
Mailing Address - Fax:314-615-8303
Practice Address - Street 1:4000 JENNINGS STATION RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-3323
Practice Address - Country:US
Practice Address - Phone:314-679-7880
Practice Address - Fax:314-679-7846
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2006007421163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse