Individual
ALYSSA VANDERSLICE HENNEBOEHLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2315 DOUGHERTY FERRY RD, SAINT LOUIS, MO 63122-3379
(314) 617-2000
Mailing address
PO BOX 740019, ATLANTA, GA 30374-0019
(773) 644-3941
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
2024019220
MO
363L00000X
Nurse Practitioner
APN.0994741-NP
CO
363LF0000X
Family Nurse Practitioner
Primary
2024019220
MO
Other
Enumeration date
09/12/2018
Last updated
01/07/2026
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