Individual
AMANDA DIERCKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
5347 GLENCULLEN WAY, SAINT LOUIS, MO 63128-4229
(314) 488-4289
Mailing address
5347 GLENCULLEN WAY, SAINT LOUIS, MO 63128-4229
(314) 488-4289
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2015039589
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2015039589
—
MO
Enumeration date
11/05/2015
Last updated
11/05/2015
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