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General NPI Number Information
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NPI Number | 1396156659
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Entity Type | Individual
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Provider Name | MANDIE DE VINCENTIS RN, MSN, ANP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/08/2014
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Last Update Date | 01/17/2020
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Provider Practice Location Address
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Address Line | 15379 RED WILLOW CT
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City | CHESTERFIELD
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State | MO
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Zip | 63017-5426
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Country | US
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Telephone | 646-354-9308
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Fax |
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Provider Business Mailing Address
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Address Line | 15379 RED WILLOW CT
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City | CHESTERFIELD
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State | MO
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Zip | 63017-5426
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Country | US
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Telephone | 646-354-9308
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2013041187
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License Number State | MO
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