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General NPI Number Information
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NPI Number | 1134779499
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Entity Type | Individual
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Provider Name | OLIVIA RUSSELYNE STAMMINGER RN
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Gender | Female
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Dates
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Enumeration Date | 09/18/2019
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Last Update Date | 09/18/2019
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Provider Practice Location Address
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Address Line | 2510 S BRENTWOOD BLVD STE 315
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City | BRENTWOOD
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State | MO
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Zip | 63144-2329
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Country | US
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Telephone | 636-224-1600
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Fax | 314-942-8820
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Provider Business Mailing Address
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Address Line | 118 N 2ND ST STE 200
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2894
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Country | US
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Telephone | 636-224-1210
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Fax | 636-946-0991
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2017024599
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License Number State | MO
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