Provider Demographics
NPI:1124620893
Name:POPLAR, MAUREEN A
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:A
Last Name:POPLAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 503643
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-3643
Mailing Address - Country:US
Mailing Address - Phone:314-839-5125
Mailing Address - Fax:314-839-5351
Practice Address - Street 1:11125 DUNN RD STE 204
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6188
Practice Address - Country:US
Practice Address - Phone:314-839-5125
Practice Address - Fax:314-839-5351
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020041026363L00000X
WI226456-30363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care