Tieskoetter, Matthew Dale

Tieskoetter, Matthew Dale is an individual health care provider with primary practice located at 12349 De Paul Dr Ste 100 , Bridgeton MO 63044-2512. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as his primary health care specialty. Tieskoetter, Matthew Dale can be contacted via phone (314) 291-7900.

Contact Information

Primary practice address
12349 De Paul Dr Ste 100 Bridgeton MO 63044-2512
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X 2020003584 Missouri

Profile Details

NPI number 1508482506
LBN Legal business name Tieskoetter, Matthew Dale
Credentials Advanced Practice Registered Nurse (APRN)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 25th, 2020
Last updated Oct 17th, 2022 - 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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