Provider Demographics
NPI:1386422509
Name:KAPELLER, MAGGIE ANNE (AGNP)
Entity type:Individual
Prefix:MS
First Name:MAGGIE
Middle Name:ANNE
Last Name:KAPELLER
Suffix:
Gender:
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-362-7260
Mailing Address - Fax:314-362-6288
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV SURG CT ADULT CARDIO, STE 8B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-7260
Practice Address - Fax:314-362-6288
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023045471363LG0600X
MO2012024315163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420134078Medicaid