Healthcare Provider Details

I. General information

NPI: 1164970273
Provider Name (Legal Business Name): ALMEDIN VALJEVCIC CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2016
Last Update Date: 09/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S EUCLID AVE CAMPUS BOX 5054
SAINT LOUIS MO
63110-1010
US

IV. Provider business mailing address

660 S EUCLID AVE CAMPUS BOX 5054
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-3077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2010024853
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: