Healthcare Provider Details

I. General information

NPI: 1912831363
Provider Name (Legal Business Name): ASHLEY MARIE POLITTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 SAVANNAH RIDGE CT
FENTON MO
63026-4833
US

IV. Provider business mailing address

202 SAVANNAH RIDGE CT
FENTON MO
63026-4833
US

V. Phone/Fax

Practice location:
  • Phone: 314-540-9934
  • Fax:
Mailing address:
  • Phone: 314-540-9934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2026031816
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: