Provider Demographics
NPI:1730504119
Name:MCDONOUGH SCHILLER, MARY (CRNA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MCDONOUGH SCHILLER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:M
Other - Last Name:MCDONOUGH-SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 S WOODS MILL RD STE 140
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-3427
Mailing Address - Country:US
Mailing Address - Phone:314-485-1101
Mailing Address - Fax:314-485-1104
Practice Address - Street 1:400 S WOODS MILL RD STE 140
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3427
Practice Address - Country:US
Practice Address - Phone:314-485-1104
Practice Address - Fax:314-485-1104
Is Sole Proprietor?:No
Enumeration Date:2014-02-21
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001016540367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered