| Doctor Name: | STEPHANIE LICKERMAN |
| NPI Number: | 1023309200 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN, ANP-BC |
| License Number: | 2011006713 |
| Business Practice Address: | 121 Saint Lukes Center Dr Ste 303 Chesterfield, MO - 630173509 |
| Business Phone Number: | 3144343278 |
| Business Fax Number: | 3145905949 |
| Mailing Address: | 121 Saint Lukes Center Dr, Ste 303 CHESTERFIELD |
| State: | MO |
| Postal Code: | 630173509 |
| Phone Number: | 3144343278 |
| Fax Number: | 3145905949 |
| NPI Enumeration Date: | 04/22/2011 |
| NPI Last Update Date: | 10/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 2011006713 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |