Healthcare Provider Details

I. General information

NPI: 1104192772
Provider Name (Legal Business Name): ANDREA N REICH PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 04/18/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6526 LANSDOWNE AVE
SAINT LOUIS MO
63109-2654
US

IV. Provider business mailing address

PO BOX 7412045
CHICAGO IL
60674-2045
US

V. Phone/Fax

Practice location:
  • Phone: 314-353-8777
  • Fax: 314-353-8772
Mailing address:
  • Phone: 314-353-8777
  • Fax: 314-353-8772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2012005442
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: