Individual
AMANDA BERTHOLOMEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
452 SOVEREIGN CT, BALLWIN, MO 63011-4447
(636) 222-8699
Mailing address
215 CEDAR MOUNTAIN DR, ROBERTSVILLE, MO 63072-2018
(314) 913-0306
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2014018635
MO
363LF0000X
Family Nurse Practitioner
2020026219
MO
Other
Enumeration date
08/03/2020
Last updated
09/08/2020
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