Provider Demographics
NPI:1588088009
Name:VANDERGRIFF, LOREN SUZANNE (ANP)
Entity type:Individual
Prefix:MRS
First Name:LOREN
Middle Name:SUZANNE
Last Name:VANDERGRIFF
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2325 DOUGHERTY FERRY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122-3356
Mailing Address - Country:US
Mailing Address - Phone:314-909-1359
Mailing Address - Fax:314-909-1370
Practice Address - Street 1:2325 DOUGHERTY FERRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122-3356
Practice Address - Country:US
Practice Address - Phone:314-909-1359
Practice Address - Fax:314-909-1370
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2014003266364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical