Doctor Name: | ADINA DIANE LUMLEY REY |
NPI Number: | 1336558014 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 2014020743 |
Business Practice Address: | 100 Medical Plz Lake St Louis, MO - 633671366 |
Business Phone Number: | 3143170600 |
Business Fax Number: | 3143170606 |
Mailing Address: | 12101 Woodcrest Executive Dr, Suite 210 SAINT LOUIS |
State: | MO |
Postal Code: | 631415047 |
Phone Number: | 3143170600 |
Fax Number: | 3143170606 |
NPI Enumeration Date: | 08/07/2014 |
NPI Last Update Date: | 08/07/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 2014020743 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |