Healthcare Provider Details

I. General information

NPI: 1295731560
Provider Name (Legal Business Name): SANDRA K FLEMMING-KOTTMAN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E CHERRY ST
TROY MO
63379-1513
US

IV. Provider business mailing address

PO BOX 38
TROY MO
63379-0038
US

V. Phone/Fax

Practice location:
  • Phone: 636-528-3329
  • Fax:
Mailing address:
  • Phone: 636-528-3389
  • Fax: 636-528-7744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number035456
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: