Healthcare Provider Details

I. General information

NPI: 1124937206
Provider Name (Legal Business Name): AMANDA J OZENBERGER RN, MSN, PCCN, CPHQ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4782 SIENNA DR
SAINT JOSEPH MO
64506-4862
US

IV. Provider business mailing address

4782 SIENNA DR
SAINT JOSEPH MO
64506-4862
US

V. Phone/Fax

Practice location:
  • Phone: 913-638-1672
  • Fax:
Mailing address:
  • Phone: 913-638-1672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2008020082
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: