Your Village Stl LLC

NPI #1205552643 in Wildwood, Missouri

Provider Information

NPI Number: 1205552643
Entity Type: Organization
Organization Name: Your Village Stl LLC
Primary Specialty: Pediatrics
Enumeration Date: Oct 18, 2022
Last Updated: Oct 18, 2022

Practice Location

Address: 1719 BIG HORN BASIN DR
City: Wildwood
State: Missouri
ZIP Code: 63011-4821
Phone: (314) 753-3982

Authorized Official

Name: JENNIFER TIETJEN, CPNP
Title: OWNER
Phone: (314) 753-3982

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X	Primary

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