Individual
AMBER VANDIVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3870 COLUMBIA AVE, OSAGE BEACH, MO 65065-8689
(573) 302-7490
Mailing address
5488 STONE LEDGE CIR, OSAGE BEACH, MO 65065-2554
(913) 620-6698
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2020000395
MO
Other
Enumeration date
04/06/2020
Last updated
04/06/2020
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