Provider Demographics
NPI:1144502253
Name:EDACHERIL, GLORIA MICHELLE PAUL (NP)
Entity type:Individual
Prefix:
First Name:GLORIA MICHELLE
Middle Name:PAUL
Last Name:EDACHERIL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 PROGRESS POINT PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-2207
Mailing Address - Country:US
Mailing Address - Phone:636-344-2400
Mailing Address - Fax:636-344-2401
Practice Address - Street 1:20 PROGRESS POINT PKWY STE 108
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368
Practice Address - Country:US
Practice Address - Phone:636-344-2400
Practice Address - Fax:636-344-2401
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2011011839363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner