| Doctor Name: | JESSICA VANLAERE |
| NPI Number: | 1508262155 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-BC |
| License Number: | 2014039716 |
| Business Practice Address: | 1000 Des Peres Rd Suite 310 Des Peres, MO - 631312050 |
| Business Phone Number: | 3148211313 |
| Business Fax Number: | 3148215670 |
| Mailing Address: | 10057 Elise Dr, SAINT LOUIS |
| State: | MO |
| Postal Code: | 631234033 |
| Phone Number: | 3148082287 |
| Fax Number: | |
| NPI Enumeration Date: | 11/10/2014 |
| NPI Last Update Date: | 11/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2014039716 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |