Healthcare Provider Details

I. General information

NPI: 1417784430
Provider Name (Legal Business Name): AMANDA CARAVELLI APRN - CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2024
Last Update Date: 09/14/2024
Certification Date: 09/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 EAGER RD STE 2F
SAINT LOUIS MO
63144-1405
US

IV. Provider business mailing address

1246 HIGHWAY 19
CUBA MO
65453-5114
US

V. Phone/Fax

Practice location:
  • Phone: 314-326-8024
  • Fax:
Mailing address:
  • Phone: 314-922-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number2024036773
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: