Healthcare Provider Details

I. General information

NPI: 1346172889
Provider Name (Legal Business Name): AMANDA MARIE VOLZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3794 RAYMOND AVE
BRIDGETON MO
63044-2929
US

IV. Provider business mailing address

3794 RAYMOND AVE
BRIDGETON MO
63044-2929
US

V. Phone/Fax

Practice location:
  • Phone: 254-371-0926
  • Fax:
Mailing address:
  • Phone: 254-371-0926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2005000309
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number04156429
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: