Individual
BRENDA S GOTTUSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
2175 CHARBONIER RD, SUITE B, FLORISSANT, MO 63031-5500
(314) 831-0181
(314) 851-4471
Mailing address
PO BOX 23340, SAINT LOUIS, MO 63156-3340
(314) 831-0181
(314) 851-4471
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
092325
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
420126401
—
MO
Enumeration date
06/08/2006
Last updated
01/31/2014
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