Individual
AMY O'CONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1603 WENTZVILLE PKWY, WENTZVILLE, MO 63385-3826
(636) 332-8228
Mailing address
PO BOX 955534, SAINT LOUIS, MO 63195-5534
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
2014037194
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2014037194
NP LICENSE
MO
Enumeration date
09/10/2015
Last updated
11/13/2020
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