Healthcare Provider Details

I. General information

NPI: 1467634048
Provider Name (Legal Business Name): AUNDREA K SCHUBBE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUDREA K ARIAS CPNP

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 05/19/2022
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 PHOENIX VILLAGE PKWY
O FALLON MO
63368-4279
US

IV. Provider business mailing address

PO BOX 23340
SAINT LOUIS MO
63156-3340
US

V. Phone/Fax

Practice location:
  • Phone: 636-561-5707
  • Fax: 314-851-4489
Mailing address:
  • Phone: 636-561-5707
  • Fax: 314-851-4489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4704218696
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP06590
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number137476
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: