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General NPI Number Information
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NPI Number | 1538642863
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Entity Type | Individual
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Provider Name | ALYSSA VANDERSLICE HENNEBOEHLE NP
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Gender | Female
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Dates
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Enumeration Date | 09/12/2018
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 3451 UNION BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63115-1142
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Country | US
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Telephone | 314-888-0970
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 740019
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City | ATLANTA
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State | GA
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Zip | 30374-0019
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Country | US
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Telephone | 773-644-3941
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2024019220
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APN.0994741-NP
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License Number State | CO
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