Individual
SANDRA AVITIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
3200 CHOUTEAU AVE, SAINT LOUIS, MO 63103-2910
(314) 977-1250
Mailing address
31 PEARTREE LN, GLEN CARBON, IL 62034-4312
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
2015026485
MO
363LF0000X
Family Nurse Practitioner
209013047
IL
363LP2300X
Primary Care Nurse Practitioner
Primary
209013047
IL
Other
Enumeration date
08/21/2015
Last updated
01/11/2018
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