Healthcare Provider Details

I. General information

NPI: 1720486582
Provider Name (Legal Business Name): ROBERT ANDREW SCHWENK FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2014
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 ANWIJO WAY
WARRENTON MO
63383-1388
US

IV. Provider business mailing address

521 ANWIJO WAY
WARRENTON MO
63383-1388
US

V. Phone/Fax

Practice location:
  • Phone: 636-456-6103
  • Fax:
Mailing address:
  • Phone: 636-456-6103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2014041459
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: