Healthcare Provider Details

I. General information

NPI: 1992097075
Provider Name (Legal Business Name): AMY CAMPION HAUCH CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL 8 WEST
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

1 CHILDRENS PL 8 WEST
SAINT LOUIS MO
63110-1002
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6078
  • Fax:
Mailing address:
  • Phone: 314-454-6078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2011005423
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: