Healthcare Provider Details

I. General information

NPI: 1346623956
Provider Name (Legal Business Name): ADRIANE MICHELLE SPRUELL ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 FOREST PARK AVE
SAINT LOUIS MO
63108-2212
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8111
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-4503
  • Fax: 314-362-4566
Mailing address:
  • Phone: 314-362-4503
  • Fax: 314-362-4566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2008023126
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number116231
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4002839
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: