Provider Demographics
NPI:1699475707
Name:YOUR DIABETES PARTNERS, LLC
Entity type:Organization
Organization Name:YOUR DIABETES PARTNERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MISCHE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CDCES
Authorized Official - Phone:636-262-9117
Mailing Address - Street 1:3451 SAINT ALBANS RD # 106
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:MO
Mailing Address - Zip Code:63073-1237
Mailing Address - Country:US
Mailing Address - Phone:636-262-9117
Mailing Address - Fax:314-310-5923
Practice Address - Street 1:408 JUNGERMANN RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2799
Practice Address - Country:US
Practice Address - Phone:636-449-5757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty