Individual
MS. AMY R BOHM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
1520 WENTZVILLE PKWY, WENTZVILLE, MO 63385-3408
(636) 497-4055
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(314) 454-2341
(314) 454-4345
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
2016033617
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420039759
—
MO
Enumeration date
05/08/2015
Last updated
09/25/2025
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