Individual provider · Type 1 NPI

Nichole Leanne Derhake, PNP

Pediatric Nurse Practitioner · St. Louis, MO

NPI number 1174075287 Active

Practice location

1 Childrens Pl
St. Louis, MO 63110-1002

Specialties and licenses

Taxonomy	Code	License
Pediatric Nurse Practitioner Primary	363LP0200X	2016035217 (MO)

Pediatric Nurse Practitioner: Definition to come...

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About NPI 1174075287

Nichole Leanne Derhake, PNP's National Provider Identifier is 1174075287, issued on Oct 25, 2016. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in St. Louis, MO. The record was last updated on May 16, 2022.