Healthcare Provider Details

I. General information

NPI: 1871031823
Provider Name (Legal Business Name): AMY MARIE DURSO MSN, RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY MARIE FRIEDEL BSN, RN

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15838 FOUNTAIN PLAZA DR STE A
CHESTERFIELD MO
63017-7469
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 636-484-5277
  • Fax: 636-484-5216
Mailing address:
  • Phone: 636-484-5277
  • Fax: 636-484-5216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.15420
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2016039171
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2016039171
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: