Healthcare Provider Details

I. General information

NPI: 1114779659
Provider Name (Legal Business Name): ANGELA NICOLE JUNGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 BELLEVUE AVE STE 15
SAINT LOUIS MO
63117-1851
US

IV. Provider business mailing address

1027 BELLEVUE AVE STE 15
SAINT LOUIS MO
63117-1851
US

V. Phone/Fax

Practice location:
  • Phone: 314-768-5375
  • Fax: 314-768-5376
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: