MEDICARE: MADELEINE BRANTLEY AGNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	2018003994	MO
2	363LG0600X	Gerontology Nurse Practitioner	2021041454	MO

General Provider Information

NPI Number	:	1487305991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELEINE BRANTLEY AGNP

Provider Business Mailing Address
First Line	:	820 BROWNELL AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-3237
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13319 MANCHESTER RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1710
Country	:	US
Telephone Number	:	314-582-5491
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2022
Last Update Date	:	05/21/2025

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Directions to “ MADELEINE BRANTLEY AGNP” Practice Location

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