Provider Demographics
NPI:1427497411
Name:BOMMEL, NASTASSIA C (DO)
Entity type:Individual
Prefix:DR
First Name:NASTASSIA
Middle Name:C
Last Name:BOMMEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:NASTASSIA
Other - Middle Name:C
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5471 DR MARTIN LUTHER KING DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-4265
Mailing Address - Country:US
Mailing Address - Phone:314-367-5820
Mailing Address - Fax:
Practice Address - Street 1:8860 LADUE RD STE 100
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2068
Practice Address - Country:US
Practice Address - Phone:314-863-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-23
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020578208000000X
MO2016010210208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics