Individual
MS. MANDY ELIZABETH BETTENHAUSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
4901 FOREST PARK AVE, DIV SURG ACCS, STE 340, SAINT LOUIS, MO 63108-1495
(314) 362-5298
(888) 824-2176
Mailing address
660 S EUCLID AVE, MSC 8109-43-1160, SAINT LOUIS, MO 63110-1010
(314) 362-5298
(888) 824-2176
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
2019008105
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420103116
—
MO
Enumeration date
09/11/2017
Last updated
08/23/2023
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