Fajic, Samra

Fajic, Samra is an individual health care provider with primary practice located at 522 N New Ballas Rd Ste 240 , Saint Louis MO 63141-6819. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Gerontology, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Fajic, Samra can be contacted via phone (314) 567-5100.

Contact Information

Primary practice address
522 N New Ballas Rd Ste 240 Saint Louis MO 63141-6819
Phone: (314) 567-5100
Fax: (314) 567-3387
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X 2020004945 Missouri
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 2020004945 Missouri

Profile Details

NPI number 1417589052
LBN Legal business name Fajic, Samra
Credentials ACNP
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 11th, 2020
Last updated Oct 17th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417589052 NPPES
Missouri MEDICAID 420081760

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