Healthcare Provider Details

I. General information

NPI: 1528209319
Provider Name (Legal Business Name): HOLLY M STRASSNER R.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HOLLY MICHELLE WATKINS RN,BSN,CNOR,RNFA,CNP

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 FAIRWAY GREEN DR
O FALLON MO
63368-4271
US

IV. Provider business mailing address

263 FAIRWAY GREEN DR
O FALLON MO
63368-4271
US

V. Phone/Fax

Practice location:
  • Phone: 636-542-1199
  • Fax: 636-594-2022
Mailing address:
  • Phone: 636-542-1199
  • Fax: 636-594-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberAG02170163
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number143433
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number02170163
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAG02170163
License Number StateMO
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAG02170163
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: